As a dentist, you’ve probably heard this question from patients (or even asked it yourself):

“If I don’t need much treatment and just get my regular cleanings, am I better off buying dental insurance — or just paying out of pocket and asking for a discount?”

With rising premiums, restrictive coverage limits, and complicated benefit rules, many patients are wondering whether dental insurance actually saves them money — especially if they’re healthy and low-risk.

Let’s dig into the math and logic to see which route makes more financial sense over a 5-year period.

🏦 Scenario 1: Paying for Dental Insurance

Let’s assume the patient purchases a typical individual PPO dental insurance plan, with:

• Monthly premium: $40–$50/month

• Annual max benefit: $1,500

• Preventive care covered at 100% (exams, cleanings, X-rays)

• Basic/major services covered at 50–80% after deductible

Over 5 years, the patient will pay:

• $50/month × 12 months × 5 years = $3,000 in premiums

Assuming they only need:

• 2 cleanings/year

• 1 exam/year

• X-rays every 1–2 years

• No major treatment

Then the insurance covers only preventive care, which might otherwise cost around $300–$400/year out-of-pocket. Over 5 years, that’s about $1,500–$2,000 worth of covered care — but the patient paid $3,000 in premiums.

📉 Net financial loss: likely $1,000+ over 5 years, assuming no other treatment.

💵 Scenario 2: Paying Out-of-Pocket with a 10% Courtesy Discount

Let’s assume the practice offers a 10% courtesy discount for patients without insurance who pay at the time of service.

Out-of-pocket pricing (estimates):

• Comprehensive exam: $100

• Cleaning: $150 × 2 = $300/year

• Bitewing X-rays (once every 1–2 years): ~$80

Average total cost per year: ~$400
With a 10% discount: ~$360/year
Over 5 years: $360 × 5 = $1,800

So over 5 years, a healthy patient paying out of pocket with a 10% discount would likely spend around $1,800 total, compared to $3,000 in insurance premiums — and they’re not locked into insurance rules, restrictions, or waiting periods.

📈 Net savings: likely $1,000–$1,200 by not having insurance — for healthy, low-utilization patients.

🧠 But What If Something Happens?

Of course, insurance is often viewed as protection for the unexpected. What if the patient ends up needing:

• A crown ($1,200)

• A deep cleaning (SRP) or root canal ($800–$1,500)?

Here’s the catch:

• Most insurance plans cap at $1,000–$1,500 per year

• Many have waiting periods for major services (6–12 months)

• There’s often a deductible, plus co-insurance

So even in a "high-treatment" year, the patient may still pay 50–70% of the cost out-of-pocket — despite paying monthly premiums.

🦷 Summary: Which Option Costs More Over 5 Years?

If a patient has insurance, they pay $3,000 in premiums, but get around $2,000 worth of treatment, resulting in a $1,000 loss. Without insurance, the patient doesn't pay any premiums, but they still receive treatment worth $1,800, meaning they either break even or could save up to $1,200.

✅ Final Thoughts for Dentists (and Their Patients)

If a patient is relatively healthy and needs only preventive care, they are very likely to spend less over time by:

• Skipping traditional insurance

• Paying out of pocket

• Asking for a courtesy or prompt-pay discount

This approach also gives dentists more flexibility to:

• Use premium materials

• Avoid insurance limitations

• Offer treatment based on clinical need, not policy restrictions

However, for patients with known treatment needs or limited financial reserves, insurance may still provide peace of mind, if not full coverage.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com