Is Dental Insurance Better Than Paying Out-of-Pocket?
If you’re living in Encino, Tarzana, Sherman Oaks, or anywhere in the San Fernando Valley, you’ve probably asked yourself: Is dental insurance really worth it, or would I be better off just paying for dental care out-of-pocket? With the rising cost of healthcare in California and the complexity of insurance plans, this question is more relevant than ever. The answer isn’t simple—and it depends entirely on your unique situation.
As a holistic dentist serving the Los Angeles area, Dr. Linda Makuta works with patients across the full spectrum—from those with comprehensive employer-sponsored insurance to those who choose to pay out-of-pocket for their care. Here’s what you need to know to make the best financial decision for your dental health.
Understanding How Dental Insurance Actually Works
Before we can compare insurance to out-of-pocket costs, it’s important to understand what dental insurance really is—and what it isn’t.
Dental Insurance Is Not Health Insurance
Unlike medical insurance, which provides catastrophic coverage and protects you from potentially devastating healthcare costs, dental insurance operates more like a discount or maintenance plan. Here’s why:
- Annual maximums: Most plans cap benefits at $1,000-$2,000 per year—unchanged since the 1970s despite inflation
- Percentage-based coverage: You still pay a portion of most procedures
- Waiting periods: Major procedures often have 6-12 month waiting periods
- Limitations and exclusions: Many procedures aren’t covered at all
- Fee schedules: Insurance determines what they’ll pay, often below actual costs
The Traditional Coverage Structure
Most dental insurance plans follow this basic structure:
- Preventive care (cleanings, exams, X-rays): 100% covered, usually twice per year
- Basic procedures (fillings, extractions): 70-80% covered
- Major procedures (crowns, bridges, implants): 50% covered (if covered at all)
- Orthodontics: Often limited coverage or not covered
- Cosmetic procedures: Not covered
The True Cost of Dental Insurance in the San Fernando Valley
Let’s break down what dental insurance really costs for a typical Encino family:
Scenario: Family of Four in Los Angeles
Monthly Premiums (Individual Plan): $120/month
Annual Premium Cost: $1,440
Deductibles: $50 per person = $200/year
Annual Maximum per Person: $1,500
Total Family Maximum: $6,000
What You’re Guaranteed to Pay: $1,640 ($1,440 premiums + $200 deductibles)
Maximum Insurance Will Pay: $6,000 total
Your Break-Even Point: You need to use at least $1,640 in covered benefits just to break even
Additional Co-pays and Coinsurance: For most procedures, you’ll still pay 20-50% of costs
The Reality Check
If your family only needs routine preventive care (cleanings and checkups twice per year), here’s what that actually costs out-of-pocket in the Encino area:
- 4 people × 2 cleanings/exams per year = 8 appointments
- Average cost: $200-$250 per cleaning/exam
- Total out-of-pocket cost: $1,600-$2,000 per year
Compare this to paying $1,440 in premiums plus $200 in deductibles ($1,640 total) for insurance that covers the same preventive care. You’re essentially breaking even—except with insurance, you’re locked into their network and restrictions.
When Dental Insurance Makes Financial Sense
Despite the limitations, dental insurance can be a smart financial move in certain situations:
Insurance Is Likely Better If:
1. Your Employer Heavily Subsidizes It
If your employer pays 50% or more of your premiums, insurance is almost always worth keeping. You’re getting significant value for minimal out-of-pocket cost.
Example: If your employer pays $100/month and you only pay $20/month ($240/year), you’re spending far less than the value of even basic preventive care.
2. You Know You Need Major Dental Work
If you’re planning crowns, bridges, or other major procedures in the near future, insurance can offset some costs—but watch for waiting periods.
Example: You need two crowns ($2,000 each = $4,000 total). Insurance covering 50% after deductible could save you ~$2,000, even after paying annual premiums.
Important caveat: Many plans have 6-12 month waiting periods for major work, so you can’t sign up specifically for an upcoming procedure.
3. You Have Children
Children need regular preventive care and are more prone to cavities. The 100% coverage of preventive care plus coverage for fillings can add up.
Example: If your kids need multiple fillings per year (each $200-$400), the 70-80% insurance coverage saves money even after premiums.
4. You Have a History of Frequent Dental Problems
If you consistently need multiple fillings, gum treatments, or other procedures each year, insurance can help spread costs.
5. You Want Predictable Monthly Expenses
Some people simply prefer the predictability of monthly premiums over the uncertainty of potential out-of-pocket expenses, even if it costs slightly more over time.
When Paying Out-of-Pocket Makes More Sense
For many health-conscious San Fernando Valley residents, paying out-of-pocket offers significant advantages:
Out-of-Pocket Is Likely Better If:
1. You Have Excellent Oral Health
If you only need routine preventive care (cleanings and exams), you’ll likely spend the same amount or less paying out-of-pocket than you would on insurance premiums.
Math: Two cleanings/exams per year at $200-$250 each = $400-$500. Compare this to typical annual premiums of $400-$600+ for individual coverage.
2. You’re Self-Employed or Insurance Isn’t Subsidized
Individual dental insurance plans (not through an employer) often cost more than the value they provide, especially for healthy individuals.
3. You Value Holistic or Alternative Treatments
Many insurance plans don’t cover biocompatible materials, mercury-free fillings, ozone therapy, or other holistic approaches offered at Encino Holistic Dentistry. Paying out-of-pocket gives you complete freedom to choose the treatments that align with your health values.
Example: Insurance might only cover amalgam (mercury) fillings, but you want mercury-free composite. With insurance, you still pay the difference. Out-of-pocket, you simply pay for what you want.
4. You Want Maximum Flexibility
Without insurance, you can:
- See any dentist you choose, not just in-network providers
- Choose the best materials and treatments without pre-authorization
- Avoid waiting periods for procedures
- Make treatment decisions based on health, not coverage limitations
5. You Can Handle Unexpected Expenses
If you have emergency savings or can comfortably handle a $1,000-$2,000 dental expense if needed, you may prefer not paying monthly premiums for coverage you may never use.
6. You’re Willing to Invest in Prevention
The best “insurance” against costly dental work is excellent home care and preventive visits. If you’re committed to this approach, you’ll likely need minimal dental work beyond cleanings.
Real-World Scenarios: Who Comes Out Ahead?
Let’s look at some specific situations common among Los Angeles area residents:
Scenario 1: Young Professional with Good Oral Health
Profile: 28-year-old working in Sherman Oaks, no dental work in 5 years, excellent home care
With Insurance (Individual Plan):
- Monthly premium: $35 ($420/year)
- Deductible: $50
- Two preventive visits: Covered 100%
- Total spent: $470/year
Out-of-Pocket:
- Two cleanings/exams at $225 each = $450
- Total spent: $450/year
Verdict: Out-of-pocket saves $20/year, plus provides freedom to choose any dentist and treatment options without restrictions.
Scenario 2: Family with Employer-Subsidized Insurance
Profile: Encino family of four, employer pays 70% of premiums, kids occasionally need fillings
With Insurance:
- Employee pays: $40/month ($480/year)
- Deductible: $200 (family)
- Preventive care (8 visits): Covered 100%
- Two fillings for kids: $300 each, insurance pays 80% = $60 each ($120 total out-of-pocket)
- Total spent: $800/year
Out-of-Pocket:
- Eight cleanings/exams at $200 each = $1,600
- Two fillings at $300 each = $600
- Total spent: $2,200/year
Verdict: Insurance saves $1,400/year—keep the insurance!
Scenario 3: Self-Employed Individual Needing Crown
Profile: 45-year-old Woodland Hills resident, needs crown this year, otherwise healthy teeth
With Insurance (Individual Plan, 12-month waiting period for major work):
- Year 1: Pay premiums ($600), can’t get crown yet (waiting period), pay out-of-pocket anyway ($1,800)
- Year 2: Pay premiums ($600), get preventive care
- Two-year total: $3,000
Out-of-Pocket:
- Year 1: Two cleanings ($400) + crown ($1,800) = $2,200
- Year 2: Two cleanings ($400)
- Two-year total: $2,600
Verdict: Out-of-pocket saves $400, plus provides immediate access to needed care without waiting periods.
Scenario 4: Holistic-Minded Patient Wanting Biocompatible Materials
Profile: Tarzana resident replacing old amalgam fillings with BPA-free composite, values holistic care
With Insurance:
- Annual premium: $500
- Deductible: $50
- Insurance covers standard composite at $200, pays 70% = $140
- BPA-free composite costs $300 (you pay difference: $160)
- Biocompatibility testing: Not covered ($150)
- Three replacements: $480 out-of-pocket + $150 testing = $630
- Total spent: $1,180/year
Out-of-Pocket at Holistic Practice:
- BPA-free composite: $300 each × 3 = $900
- Biocompatibility testing: $150
- Two preventive visits: $450
- Total spent: $1,500/year
Verdict: While insurance saves $320 this particular year, out-of-pocket provides complete freedom to choose holistic materials and treatments without fighting for coverage. For ongoing holistic care, out-of-pocket often makes more sense long-term.
The Hidden Costs of Dental Insurance
Beyond premiums and deductibles, dental insurance comes with hidden costs that San Fernando Valley residents should consider:
1. Limited Provider Networks
Many plans restrict you to in-network dentists. If you want to see a specific holistic dentist or specialist, you may pay out-of-network rates (higher out-of-pocket costs) or pay entirely out-of-pocket anyway.
2. Treatment Limitations
Insurance often dictates:
- Which materials can be used (may not cover biocompatible or premium options)
- How many preventive visits per year (usually limited to two)
- Waiting periods before major work is covered
- Frequency limits (e.g., crowns only covered every 5 years)
3. Pre-Authorization Hassles
Many procedures require pre-authorization, which can delay treatment and add administrative stress. Even with pre-authorization, insurance can deny claims after treatment.
4. The “Least Expensive Alternative Treatment” (LEAT) Rule
If multiple treatment options exist, insurance typically only covers the cheapest option, even if it’s not the best for your long-term oral health.
5. Annual Maximum Caps
Once you hit your annual maximum (typically $1,000-$2,000), you’re paying 100% out-of-pocket anyway. For extensive dental work, insurance only covers a portion of total costs.
6. Time and Stress
Dealing with insurance paperwork, claim denials, and fighting for coverage takes time and creates stress—costs that are harder to quantify but very real.
The Advantages of Out-of-Pocket Payment
Many patients at Encino Holistic Dentistry find that paying out-of-pocket offers surprising benefits:
Benefits of Out-of-Pocket Payment
1. Complete Treatment Freedom
Choose any dentist, any materials, and any treatment approach without insurance restrictions or pre-authorization requirements.
2. No Waiting Periods
Get treatment when you need it, not when insurance finally covers it.
3. Transparent Pricing
Know exactly what you’ll pay upfront—no surprise bills from insurance denials or under-coverage.
4. Access to Holistic Options
Choose biocompatible materials, mercury-free fillings, ozone therapy, and other holistic treatments without fighting for coverage.
5. Better Long-Term Relationships
Build relationships with dentists based on care quality, not just insurance networks. This continuity of care often leads to better outcomes.
6. Potential Discounts
Some dentists offer discounts for payment in full at time of service, savings you can’t get with insurance.
7. Simplified Finances
No premium payments, deductibles, co-pays, or confusing explanation of benefits (EOB) statements to decipher.
8. Flexible Payment Options
Many dental practices (including Encino Holistic Dentistry) offer payment plans through CareCredit, allowing you to spread costs over time without the ongoing commitment of insurance premiums.
Creating Your Own “Dental Insurance” Through Prevention
The best way to avoid expensive dental work isn’t insurance—it’s prevention. Here’s how to invest in your oral health:
The Preventive Investment Strategy
Instead of paying monthly insurance premiums, consider this approach:
- Set aside $50-100/month in a dedicated dental savings account
- Use funds for preventive care: Two cleanings/exams per year ($400-500)
- Build emergency reserve: Remaining money stays in your account for future needs
- Benefit from compound savings: Unlike insurance premiums (which you never get back), your savings grow
Five-Year Example:
- Save $75/month = $900/year
- Spend $450/year on preventive care
- Bank the remaining $450/year
- After 5 years: $2,250 in your dental fund
Compare this to paying insurance premiums: After 5 years, you’ve spent $3,000+ with nothing to show for it except covered preventive care—the same care you could have purchased for $2,250 while keeping $2,250 in savings.
Maximizing Your Preventive Investment
- Excellent home care: Brush twice daily, floss daily, use quality oral care products
- Healthy diet: Limit sugar and acidic foods that contribute to decay
- Regular checkups: Catch problems early when they’re less expensive to treat
- Address problems promptly: Don’t delay treatment, allowing small issues to become major problems
- Maintain overall health: Manage conditions like diabetes that affect oral health
Special Considerations for Los Angeles Area Residents
California’s Dental Insurance Landscape
California residents face unique considerations:
- No mandated adult dental coverage: Unlike some states, California doesn’t require health insurance plans to include dental coverage for adults
- Higher cost of living: Los Angeles area residents may find individual insurance premiums particularly expensive relative to the benefits
- Extensive provider networks: The San Fernando Valley has many excellent dentists, but insurance may limit your choices
- Health-conscious population: Many Los Angeles area residents prioritize holistic and biocompatible treatments that insurance often doesn’t cover
For Self-Employed Professionals
The San Fernando Valley has a significant self-employed and small business owner population. For these individuals:
- Individual insurance plans often aren’t cost-effective
- Tax-deductible health savings accounts (HSAs) or flexible spending accounts (FSAs) can offset out-of-pocket dental costs
- Building relationships with dentists who offer transparent pricing and payment plans provides better value
How to Make Your Decision: A Step-by-Step Guide
Use this framework to determine whether insurance or out-of-pocket is better for your situation:
Decision-Making Framework
Step 1: Calculate Your True Insurance Cost
- Annual premiums (minus any employer contribution)
- + Annual deductibles
- + Estimated co-pays and coinsurance for expected procedures
- = Your real annual insurance cost
Step 2: Estimate Your Out-of-Pocket Costs
- Preventive care: 2 cleanings/exams × cost per visit
- + Any known upcoming procedures (fillings, crowns, etc.)
- + Estimated costs for potential issues based on your dental history
- = Your estimated out-of-pocket annual cost
Step 3: Consider Non-Financial Factors
- Do you value holistic or biocompatible treatments?
- Do you want to choose your own dentist?
- How important is treatment flexibility?
- Can you handle unexpected expenses?
- Do you prefer predictable monthly costs?
Step 4: Run Scenarios
- Best case: Only preventive care needed—which option costs less?
- Likely case: Based on your dental history, what’s realistic?
- Worst case: If you need major work, which provides better coverage?
Step 5: Make Your Decision
If insurance costs significantly less in all scenarios and you’re comfortable with the restrictions, keep insurance. If out-of-pocket costs are similar or less, and you value the freedom, go without insurance.
Payment Options at Encino Holistic Dentistry
Whether you have insurance or pay out-of-pocket, Dr. Makuta’s practice works with you to make quality dental care accessible:
For Patients with Insurance
You can use any dental insurance plan you have. We provide detailed documentation for you to submit claims directly to your insurance company, maximizing your benefits while giving you the freedom to receive the holistic care you want.
For Out-of-Pocket Patients
- Transparent pricing: We provide clear cost estimates before any treatment
- Flexible payment plans: Through CareCredit, we offer financing options with interest-free periods
- No insurance hassles: No claim denials, no pre-authorizations, no surprise bills
- Comprehensive care: Access to all treatment options, including biocompatible and holistic approaches
The Bottom Line: Which Is Better?
There’s no universal answer—it depends on your individual circumstances. Here’s the summary:
Choose Insurance If:
- Your employer pays most of the premium
- You have children needing regular care
- You have frequent dental problems
- You’re planning major dental work (and no waiting period applies)
- You prefer predictable monthly expenses
- You’re comfortable with network restrictions
Choose Out-of-Pocket If:
- You have excellent oral health
- You’re self-employed/paying full premiums
- You value holistic treatments
- You want complete treatment freedom
- You can handle unexpected expenses
- You want to choose your own dentist
Key Insights for San Fernando Valley Residents
- For healthy adults: Out-of-pocket often costs the same or less than insurance, with more flexibility
- For families with employer plans: Insurance is usually worth keeping if heavily subsidized
- For holistic-minded patients: Out-of-pocket provides freedom to choose biocompatible materials and treatments
- For those needing major work: Insurance may help, but check waiting periods and coverage limits first
- The best investment: Regardless of your choice, excellent preventive care is the most cost-effective approach
Make the Right Choice for Your Dental Health
At Encino Holistic Dentistry, Dr. Linda Makuta provides transparent pricing and works with patients regardless of their insurance situation. Whether you have insurance or prefer to pay out-of-pocket, we’ll help you make informed decisions about your dental care and provide flexible options to make quality holistic dentistry accessible.
Serving families throughout Encino, Tarzana, Sherman Oaks, Woodland Hills, Reseda, and Van Nuys, we’re conveniently located at 5400 Balboa Blvd #211 in Encino, just down the street from Ventura Blvd.
Ready to discuss your options?
Call (818) 986-7470 or visit lindaymakutadds.com
We welcome new patients and provide clear, honest information about costs and treatment options. Let us help you achieve optimal oral health in a way that works for your budget and lifestyle.
Dr. Linda Makuta is a holistic dentist based in Encino, California, serving families throughout the San Fernando Valley. Located at 5400 Balboa Blvd #211, her practice focuses on the connection between oral health and overall wellness, using biocompatible, mercury-free materials and advanced techniques in a comfortable, family-friendly environment. Dr. Makuta offers flexible payment options through CareCredit, treating each patient with compassionate care while emphasizing education, prevention, and individualized treatment plans.
