We get a lot of questions about dental insurance. We do everything we can to work with your dental insurance company to get them to cover as much as possible.
The truth is, even at its very best, dental insurance isn’t much like medical insurance at all. It certainly helps cover some of the cost. But let’s look at what typical dental insurance really is.
Most dental insurance companies have a yearly maximum of $1000 in what they will pay for your oral health per year. Some may pay $1500, or if you’re really lucky, rarely we see a $2000 policy. This $1000-1500 amount hasn’t changed since the early 1970s. Really! And $1500 bought a whole lot more in 1970 than it does today. Dental insurance hasn’t kept up with inflation. So you’d think the premiums you or your employer pay would have stayed the same, too, right? No, they’ve risen steadily over the past 40 years.
So, what ends up happening, is that you (or your employer) pays $30 a month, which is $360 a year, for a $1000 benefit. So for signing up, you get basically get $640 to go toward dental care, if you need it. Only they aren’t going to pay 100% of anything, except maybe a cleaning. So lets say you need a crown. You pay half of the fee, and the insurance company pays half of the fee. This is typical. Only they come up with many reasons to deny you the privilege of using your coverage, for such things as:
- “waiting periods” for major work, up to a year until benefits kick in.
- “missing tooth clause” – meaning if you are missing a particular tooth at the time you sign up for the insurance, they aren’t going to help you do anything to replace that tooth in any way, shape or form.
- “replacement limits” for treatment such as partials, dentures, crowns, and fillings. For example, the insurance may say they will only pay for a new crown every 10 years. The insurance company does not take into account your susceptibility to cavities or habits such as teeth grinding that may affect how long a crown lasts.
Dental insurance will typically cover almost all the cost of a cleaning. They still don’t usually cover fluoride treatments, but for a regular 6 month cleaning, they cover most of it. However, if you have gum disease, they may not offer you that same benefit.
In summary, dental insurance, at its very best, only helps you with a checkup cleaning and work on one to two teeth per year. Here at our office, we understand that you want the most out of your dental insurance, even though it may not cover everything you need. We offer financing for dental treatment and can help you come up with financial arrangements that make sense for you.