36 Healthcare: Dental Care

In 2011, the average American household spent $286 on dentists. Obviously, some households that year were lucky enough to avoid any major expenses, while others suffered catastrophic costs that dwarfed the national averages. Before you take the chair of tooth repair, brush up on these strategies.

36.1  Follow Checklists for Products and Prescriptions

Consult Appendix 1 whenever you buy dental products. If your dentist prescribes any drugs, visit Chapter 33.

36.2  Follow Preventive Maintenance

   36.2.1  Practice Daily Maintenance
Follow a habitual path to hygienic bliss: brush, floss, and use mouthwash or rinses.

   36.2.2  Schedule Regular Checkups and Cleanings
The National Institute of Health reports that every $1 spent on prevention saves $4 on crowns, implants, and root canals.

   36.2.3  Pursue a Healthy Lifestyle
Attend to these health issues and save both teeth and money.

  • Smoking. Tobacco erodes teeth and gums.
  • Sugar. Limit to keep healthy teeth. Chew sugarless gum.
  • Diet. A balanced diet promotes healthy gums and bones.
  • Exercise. Improves circulation and immunity; benefits gums.
  • Mental Health. Less stress means fewer disorders—dry mouth, Bruxism (grinding teeth), and Temporomandibular Joint Disorder (dysfunction in the mandible and skull joint).

36.3  Run Background Checks

Whenever you vet dentists, follow Appendix 2 and these additional tactics.

   36.3.1  Seek Quality
Lowball dentists cost you more if you’re forced to fix work that wasn’t done right in the first place. (Example: a bad job on a filling eventually can lead to a root canal—I’ve been there and done that!)

   36.3.2  Ask Around
When you ask friends for referrals, ask for details about why they like their current dentist:

  • Chair side manner
    • Willingness to haggle
    •  Management of patient pain
    •  Quality of work
    •  Communication and explanations of procedures
    •  Location compared to where you work or live.

   36.3.3  Consult the Internet
Dentist reviews abound. Visit AngiesList.com or DoctorOogle.com. Angie’s List charges a monthly fee for access. One frugal approach: join for one month only, research any services you might need for the next few years, and then cancel the subscription.

   36.3.4  Take a Dentist for a Test Drive
Hire for cleanings and checkups first.

36.4  Shop Around

   36.4.1  Scope Out Daily-Deal Sites
Groupon and LivingSocial often feature good bargains on cleaning.

   36.4.2  Price Major Procedures on the Internet
Visit OneDollarDentist.com for ballpark estimates on crowns, bridges, and root canals. If you need greater precision, visit the interactive dental cost estimator at FairHealthConsumer.org.

   36.4.3  For Major Work, Seek Bids
Get the precise Current Dental Terminology (CDT) codes from your dentist or from FairHealthConsumer.org. Cite the relevant CDT codes when you call around for bids.

   36.4.4  Seek Volume Discounts
If several household members require services at the same time, it provides an opportunity to negotiate. Another approach: band together with friends who need similar services and seek a group discount.

   36.4.5  Hire Students
If price matters more to you than quality (see 36.3.1), consider visits to dentistry and hygienist schools that offer FREE or discounted services. For  a comprehensive list of programs where you live, visit NIDCR.nih.gov/FindingDentalCare.

   36.4.6  Barter or Trade
If you have tartar, consider barter. As always, beware the complex tax morass (see IRS Publication 525 and consult your advisor).

36.5  Haggle

   36.5.1  “If Insurers Pay Less, Could I Get That Price?”

   36.5.2  “Dr. X Gave a Low Bid, Could You Match His Price?”

   36.5.3  “Can You Match the Price at FairHealthConsumer.org?”

   36.5.4  “Is There a Loyalty Discount?”

36.6  Ask Your Dentist About Potential Savings

   36.6.1  Ask Whether You Need the Service
If something is fundamentally wrong, by all means fix your teeth. But if the work is purely cosmetic, do without.

   36.6.2  Ask Whether You Need New X-Rays
Some offices use x-rays to boost cash flows. You get stuck with the bill and extra radiation. According to the FDA, healthy adults at low risk for dental problems need x-rays only once every 24-36 months. If your dentist wants to zap you more than that, seek an explanation.

   36.6.3  Ask for Cheaper Options
Material costs vary. For fillings, metal costs less than resin and usually lasts longer. Crowns come in a wide variety of materials: resins, base metals, noble metals, porcelain, ceramics, and titanium. Perhaps the most expensive option isn’t your best choice.

36.7  Save With Payment Methods

   36.7.1  Tap HSA and FSA Accounts
Most dental expenses qualify for payment out of these accounts. You save because you pay with pre-tax dollars.

   36.7.2  Take Tax Deductions
Time discretionary dental work for years in which you itemize and your overall medical costs exceed 10 percent of your adjusted gross income. Consult your tax advisor. Note: payments from HSAs and FSAs don’t qualify for deductions, because you already received a tax benefit when you first funded those accounts.

   36.7.3  Seek Credit Card Rewards
If you don’t have an HSA or FSA, pay with plastic and at least rack up some rewards. And even if you do have one of these accounts, pay with plastic anyway: when you charge $1,000 to your three percent cash rewards card and reimburse yourself with a later HSA or FSA withdrawal, you pocket an extra $30.

   36.7.4  Get Financial Help
Programs help those who meet income and age requirements. Visit OralHealthAmerica.org or NIDCR.nih.gov/FindingDentalCare.

36.8  Follow Up

   36.8.1  Check the Math
Drill down into the bill’s details. Look for overcharges; confirm the accuracy of all CDT codes. Mistakes on dental bills are common. Make sure you haven’t been overcharged.

   36.8.2  Build a Relationship
If you like your dentist, refer friends. This may trigger discounts. At a minimum, it builds up goodwill for the next time you chip a tooth.

   36.8.3  Retain Paperwork
In order to document spending from medical accounts or tax deductions.

CODA: DENTAL INSURANCE AND DENTAL PLANS

I didn’t list these as strategies because of their doubtful usefulness. As to dental insurance, the cheaper policies impose low annual caps on benefits. Because of these limitations, you might decide to skip the insurance and deposit what you save on premiums into a fund that covers general emergencies, including dental expenses. If you still want to shop for coverage, eHealthInsurance.com lists policies sold in your zip code. One tax tip: dental insurance may be deductible if your overall medical costs exceed 10 percent of your adjusted gross income. Read IRS Publication 502 and consult a tax advisor.

Dental plans differ from dental insurance. In the case of plans, a company negotiates with dentists for lower rates. You pay a fee to the company in return for access to discounting dentists. Again, you probably can save more if you follow the strategies in this checklist. If you still want to shop around for plans, visit DentalPlans.com, which helps you compare prices and benefits from more than 30 companies.

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