Dear AMAC,
My Medicare plan doesn’t cover dental, so I’m looking at other options to cover me. I came across something called a dental discount plan. I’ve never heard of it before. What’s the difference between dental insurance and a dental discount plan? Which one is better?
—Margarite (Pima, AZ)
Hello Margarite,
When it comes to dental care, many seniors ask the same question: Should I choose dental insurance or a dental discount plan? While both can lower your out-of-pocket costs, they work in very different ways. Here’s what you need to know before making a decision.
How Dental Insurance Works
Dental insurance functions much like traditional health insurance. You pay a monthly premium to maintain coverage, and in return, the insurance company helps pay for certain dental services.
Most dental insurance plans include:
- A deductible, which is the amount you must pay before the plan starts sharing costs.
- Copayments or coinsurance, meaning you pay part of the bill, and the insurer pays the rest. Copays are a fixed amount, whereas coinsurance is a percentage of the cost.
- An annual benefit maximum, which is the most the plan will pay for services. This limit is often between $1,000 to $5,000. Once you reach that limit, you are responsible for any additional costs for the rest of the year.
Additionally, it’s important to understand which services are considered preventive, basic, or major. Preventive services include regular cleanings, oral exams, and bitewing x-rays. Basic services include fillings, simple extractions, and deep cleanings. Major services include oral surgery, root canals, crowns, bridges, implants, and dentures.
Preventive care is often covered at a higher percentage than basic and major services. Many plans have a 100/80/50 design, meaning they cover preventive services at 100%, basic services are covered at 80%, and major services are split down the middle (though some plans cover less). Also, if the plan has a waiting period, you may have to be enrolled for several months before major services are covered.
For seniors who want predictable costs and structured coverage, dental insurance can provide peace of mind. But if you need major services right away, be sure to check if the plan you’re considering has a waiting period. It’s also important to review the annual maximum, especially if you expect to need extensive dental work, like dental implants and oral surgery.
How Dental Discount Plans Work
Dental discount plans are not insurance. Instead of paying claims on your behalf, these plans negotiate lower prices with participating dentists.
You pay a membership fee to the plan—often annually—and in exchange, you receive discounted rates on services when you visit a dentist within the plan’s network.
Unlike insurance, discount plans typically:
- Do not have deductibles, waiting periods, or annual spending caps.
- Require you to pay the discounted fee directly to the dentist at the time of service.
Discounts can range widely, depending on the procedure and the provider. However, you are still responsible for paying the entire bill—just at a reduced rate.
For those who anticipate multiple procedures in a short period, a discount plan may offer immediate savings without the limitations of annual caps. On the other hand, if you prefer the structure of shared costs and defined coverage, traditional insurance may be a better fit.
Comparing Costs: Dental Insurance vs Dental Discount Plans
Dental insurance premiums vary depending on the level of coverage, while dental discount plans typically charge a lower annual membership fee. That can make discount plans appear more affordable upfront.
However, initial costs alone should not drive your decision. Be sure to ask your dentist about the actual discounted fees for common procedures to better understand your potential savings.
The real question is how much dental care you expect to need and how each option handles those expenses. If you are considering either option, it’s also wise to confirm that your preferred dentist participates in the network.
Other Ways to Reduce Dental Costs
In addition to insurance and discount plans, some dental offices offer in-house membership programs for patients who pay an annual fee. These plans may include routine cleanings and reduced fees for additional services.
Dental schools and community clinics may also provide reduced-cost care in certain areas. Exploring your options can help you find significant savings.
Making the Right Choice for Your Needs
All in all, the “best choice” depends on your budget, your dental health, and your long-term needs. Dental insurance offers structured cost-sharing and protection up to a set annual limit, whereas dental discount plans offer immediate, negotiated savings without waiting periods or annual limits.
At AMAC, protecting your health and your hard-earned savings matters. That’s why we provide our members with trusted dental options designed to fit your dental and budget needs.
If you have questions about dental coverage—or want to explore savings—call AMAC’s Dental Department today at 888-623-9595 or click on the button below to request more information.