26 October 2021
dental insurance
On the search for a good dentist, it’s important to consider your dental insurance. Is s/he in your network? What will be covered? How much will you owe?
I worked for two dental offices as the office manager and was responsible for insurance billing and patient communication. And let me be the first to tell you—dental insurance (and all insurance, for that matter) is complicated.
That’s why I’m here to unravel all the myths, misconceptions, terminology, and coverage for you.
Whether you’re looking for a way to understand your current dental insurance plan, deciding which one to choose, or anything in between…I’ve got you covered.
(See what I did there?)
But first, let’s talk about what dental insurance really is—and what it’s not.
The True Cost of Dental Insurance [+ Common Myths]
The word “insurance” implies an understanding that you’ll be financially protected if the worst case scenario arises. However, you may not be aware that dental insurance is vastly different than most other insurance programs in place.
Unlike medical, life insurance, and home-owners insurance, dental coverage maximums are not hundreds of thousands of dollars. So, when (not if) you end up needing care, your dental benefits will only get you so far.
Most dental insurance plans have a $1500 annual maximum. This means if you get two teeth cleanings per year and a filling or two, you’ve maxed out your dental benefits until your plan renews.
Healthcare is considered (by some schmuck who developed the system) to be a completely separate entity from dental care.
This would only make sense if your mouth was not intimately intertwined with the rest of your body.
Thank God we don’t have to buy car insurance and a separate plan for the steering wheel, right?
Assuming you have a PPO (more on that below), most plans follow a standard 100/80/50 rule.
- Preventive procedures are covered at 100%
- Basic care, such as fillings and root canals, are covered by the plan at 80%
- Major services like crowns are covered at a 50% rate.
The majority of dental health plans also require you meet a $50 deductible before they contribute to basic or major services.
The cost of procedures is also not standardized. If you live in Arizona, your crown may cost hundreds of dollars less than a person getting the same type of crown in Boston.
If you go in for your bi-yearly cleaning and find out you need a root canal and crown, your benefits will certainly be maxed out for the rest of the year. You would be left with hundreds of dollars of out of pocket costs.
That’s the opposite of medical insurance, which typically requires you pay only a small portion of costs after your deductible has been met.
For this reason, I think of dental insurance as more of a discount plan, rather than an insurance.
Finally, many dental insurance plans have waiting periods before certain work will be approved. Need orthodontic work? Your dental plan options may stipulate you be on their plan for six months before a dime can be paid out.
