Dental insurance is not insurance in the way that most people think of insurance. Dental insurance works the opposite way of all other insurance types. Other insurance types have a deductible which means you pay for your medical care, or repairs to your car/home up to a certain dollar amount and then the insurance pays for the rest of a large unexpected expense. Dental insurance is the other way around – insurance covers costs up to a maximum, and any expense above that maximum is your responsibility. The maximum amount per year that most dental insurance plans will cover is $1000-$1500 per year. This insurance maximum has not changed in 50 years. In the 1980s you could reasonably expect for an insurance plan to cover two crowns in a year. Just like a candy bar used to cost 5 cents, the cost for dental care has increased with inflation over the years, but maximums on dental insurance has not. Now a dental insurance plan would have trouble covering the full cost for one crown.
There are other ways that dental insurance companies ensure a profit for themselves. One way is by having a maximum allowable fee schedule. This is a secret fee schedule that insurance companies won’t share with us, making it difficult to provide estimates for insurance coverage without submitting paperwork before treatment. They set a maximum price for what they pay depending on your individual contract – that is to say even within the same company the fee schedule is different for everyone. Dental insurance will only cover 50-80% of treatment based on the insurance’s maximum fee schedule. For example, say a filling in our office cost $300. The insurance plan only allows a fee of $200, and only pays for 50% of treatment, then the insurance plan pays for $100 of the treatment, so your responsibility would be the remaining $200.
Additionally, if you go and buy an individual plan off the marketplace in most cases it will cover cleanings at 100% of their maximum allowable fee schedule, but you will need to pay for the plan for 12-18 months before it will cover any treatment. If you have a cavity and wait for a year and a half to have it addressed, the tooth decay will grow and often require a root canal and a crown to save and restore the tooth. This turns what was a $300 problem into a $3000 problem in order to keep your tooth.
We don’t recommend that people go out and buy individual plans for dental insurance. In most cases, it doesn’t make sense to purchase dental insurance. If you have a plan that is paid for by your employer it can be a good benefit, but individual plans are not always economical when weighing coverage vs the cost of the plan. Dental insurance is a business that needs to make a profit and they do that by having people pay more in insurance premiums than they pay out for dental care. The most cost effective way to approach care is to floss, keep good oral hygiene, and come in for regular checkups so that dental issues can be addressed early when the cost is smaller. We take a proactive approach regarding cavity and gum disease prevention and put together personalized action plans for our patients based on their risk factors and history.
Some insurance companies – for example, Delta Dental – are classified as nonprofits and are exempt from paying federal taxes.
If you’re looking for a way to spread out the cost of dental treatment to a monthly bill instead of all up front, we offer Care Credit to finance dental care up to 12 months with no interest. We’re happy to answer any questions you have regarding insurance and payment options.