DENTAL INSURANCE: THE BASICS, AND IS IT WORTH THE EXPENSE?

Did you know dental insurance isn’t insurance at all? 

An insurance plan reimburses you for a loss.  As an example, if your house burns down, your insurance company covers the loss.  If you crash your car, the insurance company covers the loss.  With an insurance plan, the insurer caries the risk.

Dental “insurance” is really a “benefit plan.”  YOU carry the risk, not the insurance company.  It is designed to cover only certain procedures, and is capped with an annual maximum.  That maximum allows the insurance company to know in advance its absolute greatest annual expenditure.  It is at levels that really haven’t changed since dental insurance was invented in 1954.  But your premiums keep increasing….

Go onto any insurance company’s website and start looking at plans you can purchase as a consumer.  Note that you’ll see the words “benefit plan” or “benefits” much more often than “insurance.”  Get the picture?

Some definitions:

MAXIMUM:  The plan maximum is the most amount of money the company will pay during the benefit period.  In 1954, that amount was about $1,000 to $1,500 per year.  If your policy kept up with inflation, that would now be roughly $10,688 to $16,031.  However, it is still between $1,000 to $2,000 per year.

EXCLUSIONS:  Many procedures are not covered, so be careful.  These can include: white fillings versus metal fillings, teeth that were missing before the new policy goes into effect, some extractions (this is new: dental policies will push the burden onto your medical plan).  Other services could include implants, crowns, or dentures.

WAITING PERIODS:  When you purchase a plan, many companies will not cover services for variable periods of time.  We have seen waiting periods up to one year!!!  So while you pay the company a monthly premium, you don’t have benefits until your Waiting Period is over.

NETWORKS:  Depending on the plan you purchase, you may be forced to go to certain offices or see certain doctors.  Otherwise, you may have no benefits.  You might have to travel 50 miles to find a participating office!

PRE-EXISTING CONDITIONS:  If you are missing teeth when you purchase the plan, the ‘insurance” company may not pay for those replacement teeth, or even decrease the benefit by the percentage of missing teeth.  For example, if you want a denture that will replace 8 teeth but 4 were missing when you bought the plan, they will pay only 50% of their portion of the denture.

LEAT: Least Expensive Alternative Treatment.  If you want implants but your “insurance” company feels a denture will get the job done and is less expensive, this is what they will pay for.  You might be on your own if you want the implants.

 on a daily basis, patients will ask me if its worth purchasing an “insurance plan” they saw advertised on TV or a flier in the mail.  Usually it is not.  You’d be better off putting those monthly premiums in YOUR pocket, rather than the insurance company’s.  But its your choice.  If all you need are cleanings and exams every 6 months, it might be worth it, as long as you don’t mind being told what office to go to.  If you need extensive care, they usually are NOT worth it: the coverage is typically very limited.

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About the author:  Dr. Ira Goldberg has been practicing dentistry for 27 years.  He holds many levels of distinction, including:  Fellow of the Academy of General Dentistry, and Diplomate of the American Board of Oral Implantology / Implant Dentistry.  He is well known for cosmetic dentistry and implant dentistry.  Please visit his website at MorrisCountyDentist.com for additional information, or call his office at (973) 328-1225.