Comparing dental plans takes more than checking the monthly premium or finding a policy that says “50% coverage for crowns.”
You need to know whether your dentist participates, whether the treatment is covered when you need it, and how much the insurer will pay before reaching its benefit limit.
Start with a written estimate from your dentist. Then compare insurance with the office’s membership plan and its price for paying directly.
For the broader explanation of these options, see our Colorado dental insurance guide.
A worksheet for comparing your options
Use the same dentist and proposed treatment when comparing prices. Otherwise, you may be comparing different services or different fee schedules.
| What to compare | Dental insurance | Dentist’s membership plan | Paying directly |
|---|---|---|---|
| Annual fixed cost | Monthly premium × 12, plus any fees | Full annual membership cost | No membership or insurance premium |
| Dentist participation | Confirm the exact network | Usually tied to the dental practice offering it | Confirm the dentist accepts direct payment |
| Routine care | Check covered services and frequency limits | Check which exams, cleanings, and X-rays are included | Get the actual prices |
| Treatment you already need | Check coverage, waiting periods, and exclusions | Ask for the member price for each procedure | Ask for a written estimate |
| Maximum insurer payment | Check the annual benefit maximum and remaining balance | No insurer pays claims; membership terms determine savings | No insurer pays claims |
| Specialist treatment | Check the specialist’s network and benefits | Ask whether discounts extend to specialists | Get a separate specialist estimate |
A discount plan is another possibility. It isn’t insurance: you pay a membership fee to access participating providers’ discounted prices. Check the actual discounted treatment price before joining.
Example: comparing a $2,200 crown
Here’s a hypothetical example showing how the numbers can work. These are invented prices and benefits, not quotes for an available Colorado plan.
Assume the same crown has a $2,200 cash price and a $2,200 in-network allowed charge under the insurance option.
| Option | Example terms | Total cost to you |
|---|---|---|
| Pay directly | $2,200 crown; no discount | $2,200 |
| Dentist membership | $300 annual membership plus 20% off the crown: $1,760 | $2,060 |
| Dental insurance | $480 annual premium; $50 deductible; insurer pays 50% afterward, limited to $1,000 in remaining annual benefits | $1,680 |
Under the insurance example, the insurer’s calculated share would be $1,075, but the $1,000 benefit limit reduces its payment. You pay the remaining $1,200 treatment charge plus $480 in premiums.
Insurance looks better in this example—but only if the crown qualifies for those benefits.
If a waiting period or exclusion means the insurer pays nothing, the same insurance option could cost $2,680: $480 in premiums plus the $2,200 treatment charge.
Actual results will differ. A membership might include routine care you would otherwise pay for, insurance might negotiate a different treatment price, or other claims might have used part of the annual benefit maximum.
Already need treatment? Check eligibility before the percentage
Ask these questions before enrolling:
- Will this exact procedure be covered on the planned treatment date?
- Does a waiting period apply, and can previous coverage satisfy it?
- Are there restrictions involving missing teeth, implants, or replacement work?
- How much of the annual benefit maximum will be available?
- Does the plan pay based on the proposed treatment or a less expensive alternative?
- Are there additional charges that the estimate leaves out?
“Major services covered” isn’t enough information to answer those questions.
For substantial treatment, ask about a pretreatment estimate from the insurer. It can clarify expected benefits, although it isn’t a guarantee of payment.
Compare routine care separately
If you mainly expect exams and cleanings, add up what those services would cost directly and under the dentist’s membership program.
Then compare that with the full annual insurance premium and any additional charges.
The answer may be different for someone expecting several covered procedures. There isn’t one option that offers the best value for every household.
My starting recommendation
If you already have a dentist you like, ask about the office’s in-house membership plan first. I often recommend checking that option before buying insurance.
Then compare the actual prices and terms. Insurance may offer better savings, particularly when the benefits fit the care you need. A membership or direct payment may be simpler and less expensive in another situation.
Help comparing dental coverage
Contact us with your dentist’s name, who needs coverage, and whether you’re comparing routine care or known treatment.
We can help you understand the insurance options. If the dentist’s own program looks like the better fit, I’ll tell you that.