Dental Insurance – part 2/3

Wednesday August 03, 2022

Last week I explained how dental insurance works in general, and why there is no “good” dental insurance. This week I will break down the general differences between dental insurances, offer some things to consider when using your dental insurance, and when it makes sense to consider purchasing insurance if you don’t have it.

We get asked just about daily by patients who are either self-employed or are not offered insurance through their employer, “Should I consider getting dental insurance?” In most cases, it does not make sense to purchase dental insurance on your own. This goes back to last week’s column as to how dental “insurance” is set up to begin with. 

As discussed last week, all dental insurance companies set a limit as to how much they will “pay-out” on an annual basis. The industry average is $1000 per year, which has not changed since the inception of dental insurance back in the 1970’s. The premiums for individual dental insurance run around the $700 range. This leaves the patient with a net gain of $300 from the insurance company. This especially does not make sense if you typically only have your teeth cleaned a couple of times a year. The only way purchasing your own insurance may make sense is if you are looking to cover your entire family. You should discuss these factors with your dental office prior to making the decision. Key: You should be the one to make the decision who you pick as a dental provider, not an insurance company that might be a different company or have a new set of rules next year. 

In dentistry, there are a few types of dental insurance available. There are “open” insurance plans, where patients can go to whoever they want and a certain percentage of the fee will be covered depending on the procedure. The other types of insurance are PPO’s, HMO’s and discount plans or “clubs”. With these types of insurance, the dentist has to sign a contract with the insurance company and abide by a pre-set limit they can charge for all procedures. While this may sound good from a patient perspective, there are other things to consider.

Many private dental offices are being bought-up by larger corporations across the country. In general, the business model of these practices is to see a higher volume of patients to do more procedures. There will be less and less privately-owned dental practices as time goes on. However, in our area right now, most dental offices are small businesses. The decision for the dentist to sign-up for a particular plan depends on many factors. 

As a consumer, and patient, you have to be the one to decide what is important to you. Keep in mind that dentistry is not a commodity. Dentistry should be relationship based. Approaching it this way will give you the best opportunity to get the level of care that is right for you. 

Please keep in mind: Insurance does not equal health. Health requires investment and personal responsibility. Better access to care across the general population is a topic for another time. Right now, you have full control in managing your dental health care. You should talk to your dental office about any concerns you have.

Next week I will discuss the costs of dental care for those with or without dental insurance and ways to get what you want with regards to your dental health.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at

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