All the time I am asked,“What dental insurance should I purchase,” “Do you accept my insurance,” or “What will my insurance cover?”
With health insurance being widely discussed right now, I will explain the history on dental insurance and how it works differently than most other types of insurance and my suggestions of what type is best for you and your family.
Dental insurance plans arose back in the 1960’s, where most of them allowed you to go to any dentist and there were few restrictions on what they would cover. The yearly benefit maximums were about one thousand dollars. Unfortunately, nearly 50 years later benefits are about the same and have not kept up with inflation, yet your premiums have. If the cost of living increases are taken into account, your dental benefits should be about six thousand dollars per year! You could have had major work done in the 1960’s or 70’s for one thousand dollars, whereas now it will barely cover a crown.
Most insurances that you purchase are to cover you from a major catastrophe, such as your car getting into a bad accident, your house getting damaged in a hurricane, or going to the hospital for major surgery. You would not make a claim on your insurance if you got a small dent on your car door, had a piece of wood trim rot on your house, or got a cut on your finger. This is because your insurance isn’t going to cover it due to your deductible being higher than the claim. With dental insurance, there is usually a small yearly deductible to pay and it covers inexpensive, preventative treatment at 80-100%. But if you need something major, like a bridge, implant, dentures or surgery, it will cover a smaller percentage and your yearly maximum of $1,000-$1,500 dollars does not even come close to the cost of the procedure.
Most types of insurance you purchase require you to complete a physical examination or inspection to determine your risks and coverage needs before your premium is assigned. With dental insurance, you have no exam done to determine your needs and get a “one size fits all” plan. Your coverage options usually end up being chosen by your employer as an added benefit to you. Dental insurance is a contract between you or your employer and your insurance company, with the dentists many times not being able to tell you your exact costs without a pre-treatment estimate.
There are several types of dental insurances available. The best type to get is an indemnity plan, which is true dental insurance that pays a percentage of the dentist’s fees. It allows you to go to any dentist of your choice and you do not have to worry about set fee schedules or a list of participating doctors. The next type is a participating provider or a PPO plan. With this type of insurance you can still go to any dentist of your choice, but the insurance company sets a fee schedule for what it will pay for all procedures, called usual and customary fees. If a dentist contracts with the insurance company, they agree to take a lower fee for their work. The insurance company covers a percentage of the fee either way, but the contracted dentist’s fee is usually lower. Then there are dental health managed organizations (DMO’s), where you must stay in-network to receive any benefits. These are the cheapest plans where you will be provided with the lowest quality of benefits. I recommend staying away from this type of plan.
Unfortunately, as you move down in the level of insurance plan you select, you also drop down in the quality of care you receive. Some patients may feel “nickel and dimed” to make up for lower fees paid, provided treatments not covered by the plan, or wait a long time to get treatment, then rushed through it when they do. This may not sound like a kind thing to say, but you always get what you pay for…and sometimes you even end up paying for more.
My advice to you is if you have great teeth and only require regular cleanings and the occasional filling, dental insurance is not worth your investment. On the other hand, if you have a lot of restorative work in your mouth or find yourself to have frequent dental needs, choose an indemnity or premium PPO insurance plan so you will be able to receive the best quality work from the dentist of your choice. If your family has children, make sure you get orthodontic coverage as a benefit and also find out what the waiting periods are for treatment.
If you already have dental insurance, be aware that most plan’s benefits expire at the end of the year. So if you don’t use it, you lose it! I wish everyone a safe and happy holiday season. If you have questions on any of this information, feel free to contact my office.
Helping you smile with confidence,