Discount dental plans: A possible alternative for individuals who can't find dental insurance coverage.

It may be difficult for an individual (or individual family) to find suitable dental insurance on the open market. And as discouraging as this may seem, it's easy enough to understand why a company might want to shy away from issuing individual dental insurance policies if you look at things from their perspective.

» Insurance companies will only sell dental policies that are profitable for them.

It's a simple fact that many people looking to initiate a dental plan for themselves as an individual (or for their family) are motivated to do so by the fact that they have extensive immediate dental treatment needs. These same people, however, are of course those that it will be most costly for a dental insurance company to provide coverage for. If an insurance company were to sell dental plans on an unrestricted basis to any and all comers, in a relatively short amount of time they might very well find themselves out of business. (Not unlike a company selling flood insurance policies in a town where the local river has already started to spill over its banks.) As a means to limit their financial exposure, insurance companies typically prefer those situations where their risk is spread out among the members of a group such as the employees of a large business or members of a big organization. Doing so provides some protection for the insurance company because even though some of the newly insured will have immediate needs, most will not.

In those cases where an individual dental insurance plan can be found, the policy that is offered will typically contain terms and conditions that help to protect the insurance company's financial exposure. As an example, the plan will probably contain clauses that limit benefits (either in terms of procedures covered or the maximum amount of benefits paid) or require substantial copayments, or both. These limitations may remain in place for the duration of the policy, or possibly just during an initial time period (first six months, one year, etc...).

A discount dental plan (reduced fee-for-service dental plans) might provide an alternative to dental insurance for some individuals.

In many markets, the type of option that is most available for the individual or individual family searching for dental coverage is the discount dental plan (reduced fee-for-service dental plans). This type of dental coverage isn't really insurance but is instead simply an arrangement where the company that sells the plan has contracted with participating dentists (or dental offices) who have agreed (in return for the company referring patients to them) to provide treatment for the plan's enrolled members at a discount (typically as outlined by the dental plan's fee schedule).

» Why discount dental plans are usually easier to find than dental insurance plans.

The features of a discount dental plan can be attractive for those who do have significant and immediate dental needs because they are typically unencumbered by strict wait period, pre-existing condition stipulations or maximum benefit limitations. One reason for this is because the company that has sold the plan to the individual has little financial exposure. Their role is primarily that of a patient referring agent. They collect a fee (monthly, annual) from the dental plan subscriber but otherwise have no financial risk associated with the degree to which the plan's benefits are utilized.

The bulk of the financial risk associated with discount dental plans is instead transferred to the participating dentist or dental office. Those patients with significant dental needs will require greater amounts of discounted dental treatment. For the dentist, the influx of new patients that participate in the dental plan may make it possible for them to reach an "economy of scale" that allows them to provide this discounted work while maintaining a suitable profit margin. In other cases, however, the financial loss associated with providing certain procedures may be motivation for them to encourage patients to opt for off-plan "upgrades" or "add-ons," so to restore their profit margin.

» You can't expect to get something for nothing.

In defense of discount plans, the reality of the matter is that both traditional dental insurance and discount dental plans have the potential to be manipulated by an unscrupulous dentist in terms of recommending "upgrades" or "add-on" treatments. And by no means are we suggesting that this is the norm or to be expected. At the same time though, we do feel that it is important to point out that in those cases where a particular type of dental coverage seems "too good to be true" (such as too discounted, or too unlimited or unrestricted) that the dental patient should enter into the relationship with open eyes. To stay in business, the dentist has to be making money somehow.

We discuss specifics about discount dental plans in much greater detail on this page.