Did you know? In the 1960s dental insurance companies paid a yearly maximum of $1,000 and that number has not swayed over the past four decades? The average dental insurance pays a maximum of $1,200 per year.
Dental costs are on the rise and if you are like most you want to know should you purchase dental insurance. Many dental offices now offer great specials to first time patients for a full exam, x-rays, and most include a cleaning. Before deciding to purchase insurance opt for one of these appointments and talk with the dentist about how much treatment you will need. The dental office can help you decide which option would be best for you.
You should investigate the differences between using the proposed insurance through your employer or buying one independently. Weigh the monthly costs of dental insurance versus paying out of pocket for your dental treatment and see what works for you and your family.
A difficult fact for many patients but something very important to remember is that dental insurance is not similar to medical insurance. Many patients are shocked to realize that even though they are covered at 90% that they still have a big balance. The majority of dental insurance plans are designed with the purpose of only covering the basic dental care, about $1,000 to $1,500 per year, and is not intended to provide comprehensive coverage like that of medical insurance.
You might have heard the financial person at your dentist say, “you’re maxed out.” That is a term referring to your yearly maximum that the dental insurance plan will pay for the year. Any service you receive is taken from your yearly maximum. So even if your cleanings and other preventative services are covered at 100% they are done so because it is taken from allowed maximum allowance from the insurance company.
For example, if you have a yearly maximum of $1,200 and you saw your dentist in January and again in July for your biannual cleaning and check-ups at $300 per visit you would have a remaining available maximum of $600 for anything that may come up such as a filling or dental emergency. The yearly maximum will renew automatically each year and any unused benefits will not be rolled over into the next year. Each member of your family has their own yearly maximum so you will not be sharing benefits.
In/Out of Network Dentists
There are HMOs which require you to go to a specific dentist and then there are PPOs which were designed to allow the patient to pick their dentist. However, more independent insurance companies are popping up calling themselves “PPO” but now have distinguished between in-network and out-of-network. It is the patient’s responsibility to verify if their dentist is in or out of network. However, the differences are very minimal. If you have a dentist you like, trust, and are comfortable with stick it out.
- Co-pay? A lot of insurances have them but not the majority of PPOs. And if the insurance requires one and the dentist doesn’t make you pay for it then that is a red flag. That flag is called insurance fraud. While it may make things better for you right then it could certainly cause trouble in the long run.
- Is there a “missing tooth clause” for people with missing teeth that they may want replaced later with a bridge, partial, or implant.
- Differences in coverage for preventative, basic, and major work should be similar to other major insurance plans. Make sure that for preventative services that x-rays are covered, that root canals are covered under basic, and that they don’t have a missing tooth clause under major work. If you know you will need major work but your plan doesn’t cover it then you might want to look into switching or finding other ways to pay for your treatment.
- Typical coverage: Preventative = 100%, Basic = 80%, Major = 50%
- Most dental offices these days do not use amalgam (or silver) fillings, but insurances will not cover the full cost of a white filling, it would be a good thing to ask about.
- Waiting periods – are there long periods of time required to pass before the insurance company will allow treatment to be redone on a tooth. For instance, if you had a filling 3 years ago that needs to be redone and your insurance has a 5 year waiting period, then they aren’t going to cover any of it.
- All dental insurance companies are not alike so you must figure out which procedures fall under each category.
Dental insurances companies are raking in a lot of dough between your monthly premiums and your co-pays. Make sure that you are making the best decision for you and your family.
Yearly maximums are not going to be going up anytime soon and dentists know that. To help finance your dental care, many dental offices are now offering interest-free payment plans.