Understanding The Benefits – And Limitations – Of Dental Insurance

Most of us think of insurance as a means to protect us and our families from unforeseen loss. While that’s the general definition, some insurance plans — like dental — don’t quite work that way.

The typical dental plan actually works more like a discount coupon for dental services. Most are part of an employer-based benefit package and usually “fee-for-service”: the insurance company pays for part or sometimes the entire bill after your dental visit based on a fee schedule laid out in the policy.

A plan’s benefits depend on what the insurer offers to cover and what level of coverage your employer (or you) are willing to pay for. Typically, the more items covered under the policy, the higher the premium. Any deductibles (the amount you must pay out of pocket before receiving any plan benefits) can also affect the premium — the lower the deductible, the higher the premium.

The benefits may also be limited due to what a patient’s dentist charges for services. Most insurers pay benefits based on what they determine to be the “usual, customary, and reasonable” (UCR) fee for a particular service. The dentist’s fees are most often higher, however, resulting in the patient paying a higher percentage of the bill.

Still, a dental plan can work to your financial advantage, especially if it’s employer-based with premiums paid by your employer. It may not be advantageous, however, if you’re paying the premiums. For example, a person without insurance might spend on average $200 a year for basic dental care (mostly preventative — checkups and cleanings), while a person with insurance may have those expenses covered, but are paying yearly premiums of $500 or more for the plan.

You should also consider one other factor: our first priority as dentists is to pursue the best course of treatment for your particular dental needs, which may not always align with what your policy covers. At the same time, we understand the limitations you may be under with your plan — we work in this world every day. We’ll certainly assist you in navigating the insurance waters to achieve the best care for what you can afford.

If you would like more information on dental insurance and other financial arrangements, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Insurance 101.”