Chew on this: Roughly 74 million Americans do not have dental insurance — that translates to about 23% of the population and is more than double the percentage of those without medical insurance.
If you’re among this number, do you really need it?
To help you decide, this article outlines everything you need to know about dental insurance — including a few myths that may surprise you.
A brief history of dental insurance
We won’t get too far into the weeds, but when it comes to the origin of dental insurance, there’s a big myth we need to debunk right away…
Myth #1: Dental insurance is the same as medical insurance.
This simply isn’t true.
Both in its purpose and its function, dental coverage is quite different than medical insurance. This fact dates back to the 1850s when medical insurance was first introduced without dental care benefits. And it wasn’t until 1954 that dental insurance finally emerged.
Dental and medical insurance aren’t just separate plans, they also have key differences when it comes to…
- Premiums and deductibles
- In and out-of-network coverage
- Types of covered treatments
We’ve found that it’s this last point — the types of treatments that are covered — that many people have questions about
Let’s take a closer look.
What does dental insurance cover?
Dental plan coverage is typically grouped into 3 categories:
|Types of Treatments|
|Preventive||Twice-a-year dental checkups, cleanings, x-rays, sealants, etc.|
|Basic||Gum disease treatments, extractions, fillings, root canals, etc.|
|Major||Crowns, bridges, implants, dentures, etc.|
Most insurance operate with a 100/80/50 approach. Meaning they cover 100% (or a large majority) of preventive treatments, 70-80% of basic treatments, and 50% or less of major treatments.
Your plan may include only preventive care or a combination of preventive and basic treatments, or all three. Some types of treatments will be included in your coverage and others won’t at all. Additionally, treatments may be categorized differently according to the plan.
Just like your smile, every insurance plan is unique. The only way to know for sure if a certain treatment is covered by your plan (and by what percentage) is to talk with your dentist and/or your carrier.
This brings up another common misconception about dental insurance that we need to debunk…
Myth #2: Your dental insurance dictates the care you receive.
Quite the opposite. Dental insurance is not meant to inform decisions about your dental health. In fact, you should never allow your dental benefit plan to restrict or limit the care you need.
Insurance is a tool that helps to pay for your treatment, not something you rely on when making decisions for your health. And while your budget will of course influence your decisions, remember that your dental health IS your health — and your health is worth the investment.
So how exactly does dental insurance work?
We’ll answer this by setting another myth straight…
Myth #3: Dental insurance pays for my dental care.
The truth is that dental insurance is a way to save on your dental treatments, not cover the full cost of every treatment.
This type of insurance is quite different from other types of insurance. Take auto insurance for example. If your car is damaged, your insurance will pay to fix your car. But if your tooth is damaged, your dental insurance won’t pay for all of it.
Instead, dental insurance is similar to a cost-savings membership. The cost of a dental treatment is split between you and your insurance company. The portion your insurance company pays is determined by…
- The type of plan you have
- Whether the procedure is considered preventive, basic, or major
- Whether or not the treatment is included under your plan
An insurance company will only contribute up to a certain total amount every year. This limit typically falls between $1,000 to $2,000. Unlike medical insurance, which covers the costs after your bills reach the amount of your deductible, once your dental insurance reaches its annual benefit cap you pay any additional costs out-of-pocket. And don’t forget, you’ll also still have a copay for most treatments.
Does dental insurance save you money?
It’s time to address the final misconception…
Myth #4: Dental insurance always saves you money.
Here’s the truth: In some cases, dental coverage won’t save you any money. With or without dental insurance, you’ll need to include dental care costs in your budget.
Here’s an example to help explain…
With dental insurance, you pay a yearly premium — let’s say $600 with maximum benefit of $2000.
Your twice-a-year preventive exams and cleanings are typically included in your plan and count toward your maximum benefit amount. If you don’t need additional dental work aside from your preventive care, you may or may not end up losing some money that year, depending on the cost of care at your dentist office.
On the other hand, if you end up needing dental work that year in addition to your preventive care — say a root canal, some fillings, and a crown — you’ll definitely take advantage of your full allowance and likely exceed your $2000 maximum.
In both cases, remember that you’ll still have out-of-pocket costs. You’ll be responsible for your portion of the bill, which for major procedures can reach 50% or more.
So… is dental insurance worth it?
There is no one right answer for this question. You need to consider your specific situation and do your own calculations to determine whether you’re likely to come out ahead. Some specific things to consider include…
- The insurance plan in question
- When the insurance benefits go into effect (there’s usually a waiting period)
- Your dental health needs
- Cost of treatments
One thing is certain…you dental health IS worth it
Whether or not you have dental insurance, taking care of your teeth is incredibly important to your overall health and wellness — especially considering poor dental health has been linked to serious problems like…
- Heart disease
- Alzheimer’s disease
- Diabetic complications
Putting off care not only exacerbates the specific issue in question, it also causes more damage to your overall health and your wallet. You can’t afford to NOT care for your dental health.
We’re here to help
At First Impressions Dentistry, it doesn’t matter whether or not you have insurance. Our goal is to help every patient achieve excellent health through the highest quality dental care and treatments in OKC and Yukon.
We gladly accept most major insurances and can prepare paperwork on your behalf and help make sure you get the most out of your plan. We also provide great payment options for patients without dental insurance — including CareCredit and a dental health savings plan.
We know unexpected bills, confusion over what’s covered and what’s not, and fear of not being able to afford your care can cause stress and worry. We work hard to make sure this doesn’t happen, explaining everything along the way and assisting in any way we can.
We’re on your side and are here to help.