Can You Use a Dental Discount Plan With Insurance?

Dental care can be a significant expense, leading many to explore various options for managing costs. Two common avenues for dental savings are traditional dental insurance and dental discount plans. While both aim to reduce out-of-pocket expenses, they operate on fundamentally different models. This article clarifies how these two options function and how they might interact to help individuals make informed decisions about their dental care financing.

Distinctions Between Dental Insurance and Discount Plans

Dental insurance operates similarly to health insurance, requiring regular premium payments, monthly or annually. After meeting a deductible, which can range from $25 to $100 per person annually, the insurance plan typically covers a percentage of dental costs, up to a stated annual maximum, which commonly ranges from $1,000 to $2,000. Many plans categorize services as preventive (e.g., cleanings, exams, X-rays), basic (e.g., fillings, extractions), and major (e.g., crowns, root canals), covering them at varying percentages, such as 100% for preventive, 80% for basic, and 50% for major services. Patients may also encounter co-insurance, which is a percentage of costs they pay after the deductible, or fixed co-payments for certain services. Insurance plans often involve in-network providers, though some PPO plans may offer partial benefits for out-of-network care.

Dental discount plans, also known as dental savings plans, function as membership programs rather than insurance. Individuals pay an annual membership fee, typically around $100 to $200, to gain access to a network of participating dentists who have agreed to provide services at pre-negotiated, reduced rates. Unlike insurance, these plans do not involve deductibles, co-pays, annual maximums, or claims processes. The discount, ranging from 10% to 60% of the usual cost, is applied at the point of service, meaning the patient pays the discounted amount directly to the dentist. These plans also have no waiting periods, allowing immediate access to discounted care.

Scenarios for Combining or Choosing

It is not possible to “stack” or combine both dental insurance and a dental discount plan for the same dental procedure. Insurance typically processes the claim first, and the remaining patient responsibility cannot then be discounted by a separate discount plan for that specific service. This practice could violate agreements between providers and the plans.

Despite this, there are scenarios where having both can be beneficial for different services or at different times. If a procedure is covered by insurance, individuals should use their insurance benefits first. A dental discount plan can be useful for services not covered by insurance, such as cosmetic dentistry, or for services needed after an insurance plan’s annual maximum has been reached. For example, if an insurance plan has an annual maximum of $1,500 and a patient needs additional treatment beyond that limit, a discount plan could then be used for those subsequent services.

Discount plans can also provide savings for procedures that have waiting periods under insurance, allowing immediate access to care. The dental provider’s policies and their agreements with both the insurance company and the discount plan determine what is permissible. Patients should always confirm with their dentist’s office how their specific plans can be applied.

Key Considerations When Using Both or Deciding Between Them

When considering whether to use both a dental discount plan and dental insurance, or to choose between them, provider acceptance is a primary factor. Confirming with your current or desired dental provider whether they accept both your specific insurance and the discount plan is an important first step. Not all dentists participate in every plan or network.

A cost-benefit analysis should compare the annual membership fee of a discount plan against potential savings, especially if dental insurance coverage is robust or dental needs are minimal. A discount plan might offer significant savings if extensive dental work is anticipated or if insurance has limited coverage for certain procedures. Evaluate how each option aligns with specific dental needs, whether for routine cleanings or major restorative work, as this influences which option provides better value.

Consider the implications of annual maximums and waiting periods. A discount plan can be a valuable tool once insurance annual maximums are met, ensuring continued access to reduced-cost care. Similarly, if immediate dental care is needed and an insurance plan has waiting periods for certain procedures, a discount plan can help avoid delays. Finally, consider the flexibility regarding provider choice; some insurance plans offer wider networks than discount plans.