Dental insurance is worth it when the plan will pay more for your care this year than you pay in premiums, and not otherwise. That sounds obvious, but one number makes it easy to check: the plan’s annual maximum. It is the most the plan will pay in a year, so the most a plan can ever save you is its annual maximum minus your premiums. For a plan with a $1,500 cap and $40 a month in premiums, that ceiling is $1,020, whether your bill is $2,000 or $20,000.
We don’t sell insurance or earn anything if you enroll. This is the math we’d want someone to show us before choosing a plan during fall open enrollment.
The five numbers to find in any plan
Every dental plan’s summary of benefits lists these. Write them down for each plan you are comparing:
- Premium. What you pay per month, times 12.
- Annual maximum. The most the plan pays per person per year. According to the American Dental Association, about a third of plans (32.8%) cap benefits between $1,000 and $1,500, and nearly half (48.2%) between $1,500 and $2,500. Many still use a $1,000 level set about 40 years ago.
- Coverage percentages. Plans usually pay a higher share for preventive care, such as cleanings and X-rays, and a lower share for “major” work like crowns, bridges and dentures. The exact split is in the plan summary.
- Deductible. What you pay before the plan starts paying for basic or major work.
- Waiting periods. How long after enrolling before the plan covers each category. It matters most when the plan is new.
A worked example
Here is one example plan, made up for illustration: $40 a month ($480 a year), a $50 deductible, 100% for preventive care, 50% for major work, a $1,500 annual maximum, and a 12-month waiting period on major work. We priced treatment using the national averages from our guides: $265 for a routine visit with exam and X-rays, $1,300 for a crown, and $3,750 for a single implant.
| Your year | Without insurance | With the plan, incl. premiums | Plan saves you |
|---|---|---|---|
| Two checkups only | $530 | $480 | $50 |
| Two checkups + a crown | $1,830 | $1,155 | $675 |
| Same, but the crown falls in the waiting period | $1,830 | $1,780 | $50 |
| Two checkups + an implant (if covered at 50%) | $4,280 | $3,260 (plan hits its $1,500 cap) | $1,020 |
What the table shows:
- Checkups alone roughly break even. The plan pays back about what it costs.
- A plan pays off most in a year with one mid-size covered treatment, like a crown that falls within the cap.
- Big treatment hits the cap. However expensive the implant, the plan’s contribution stops at $1,500. The saving can never exceed $1,020.
- Waiting periods decide everything for new plans. Buying a plan for a crown you need next month often doesn’t work.
Two things the example leaves out, which can shift the math either way. Plans usually pay in-network dentists a negotiated fee, which can be lower than the cash price. On the other hand, paying yourself can come with a self-pay discount, which many offices give for paying in full. Our dental insurance calculator runs the same math with your own plan’s numbers and treatment.
When insurance is likely worth it
- Your employer pays part of the premium. Your side of the math gets much cheaper.
- You already know you need covered work next year and the plan’s waiting periods won’t block it.
- You have children in the plan who need regular preventive care, if the family premium is reasonable.
- You want protection against a surprise. Even a plan that only breaks even on checkups helps pay for an unexpected root canal and crown, up to its annual maximum.
When paying yourself is often cheaper
- You only expect cleanings, and the premiums cost about the same as the visits.
- The treatment you need is large, like implants or full dentures, where the annual maximum covers only a small slice.
- The work falls inside a waiting period.
If you go without insurance, the debt-free alternatives make a real difference. Dental school clinics charge well below private practices. Many offices discount for paying in full. And pre-tax money from an HSA or FSA lowers the effective price of treatment by your tax rate. For more ideas, see our guide to going to the dentist without insurance.
If you already have a plan: use the annual maximum on purpose
First, check whether your plan lets unused benefits roll over into the next year. If it doesn’t, whatever you haven’t used by the end of the benefit year is gone. Two habits help:
- Ask for a pre-treatment estimate. Before major work, ask the dentist’s office to send the treatment plan to your insurer. The estimate shows what the plan will pay, so the cap doesn’t surprise you.
- Split treatment across benefit years when it’s safe. If you need two crowns and your plan’s year ends December 31, doing one in December and one in January can let two annual maximums pay instead of one. Ask your dentist whether waiting is safe for your teeth first. A tooth that gets worse while you wait can cost more than the benefit you save.
If you buy coverage on the Health Insurance Marketplace, check the dental part carefully. According to HealthCare.gov, some Marketplace health plans include dental coverage and in some cases separate dental plans are offered, but for adults dental “isn’t an essential health benefit,” so health plans don’t have to include it.