Dental “insurance” is an unfortunate misnomer. Insurance is a protection against loss from a company that combines risk to make payments for insured people affordable. An insurance policy hedges against the risk of financial loss. Medical insurance is true insurance in this way. You may have to pay an awful lot out of pocket, but if your medical needs balloon past your deductible, your insurance company picks up the tab so you aren’t responsible for hundreds of thousands of dollars in out of pocket medical costs.
The dental policy you purchase from your employer or on the open market works nothing like this. With dental “insurance”, you are usually entitled to two cleanings and regular exams, along with some x-rays each year. There are limitations for each procedure that are arbitrary and have no relationship with your specific oral health needs. For instance, your plan may pay for two dental cleanings per year, but if you have bleeding gums, large pockets between the gums and teeth, or bone loss, you may not qualify for a basic cleaning. In fact, it would constitute medical negligence for a licensed dental professional to provide you with a service that does not address your health needs. You may need a periodontal cleaning, sometimes referred to as a “deep cleaning”. If your policy won’t pay 100% for this, don’t automatically think you shouldn’t get it. Imagine going to the doctor with a broken bone and demanding only a Band-Aid because it’s all your insurance covers.
After your “free” cleanings and exams, most plans will give you a discount on treatment, but only to a certain amount per year. Once you’ve reached that amount, you’re on your own. Again, this setup does not take into consideration your oral health needs. I’ve had patients hear that their plan has a maximum and they will have to pay out of pocket and angrily state that they will be calling their insurance company and demanding payment. “As much as I’ve had to pay each month, they better pay for this!” I have compassion for these patients because no one explained to them how their plan works. They thought they had dental insurance. What they actually have is dental benefits.
Another way to look at your plan is like a dental coupon. Your coupon entitles you to certain benefits, like the cleanings, exams, and x-rays I’ve already mentioned. Your coupon also gets you a discount on certain services that you may need. The amount of benefit you can receive will be based on many factors but once the coupon has run out, you have to wait for the plan to renew.
“Why should I even get dental insurance then?”
Many people, when they realize how it works, decide not to purchase dental benefits. The choice is yours, but the advice I would offer is that if you are going to purchase it, make sure you use it! Get every “free” benefit out of it you can. That means, get to your dentist for every dental cleaning your plan will pay for. Most plans pay for two, so keep your hygiene appointments. If you remain updated and current on all your x-rays, get your dental cleanings, and have a doctor examine your mouth twice a year, your premiums will pay for themselves. Then, if your dentist discovers an area of decay, take care of it quickly. The amount you pay out of pocket will not be overwhelming and it will avoid future problems. If your doctor says you have problem areas in your teeth, roots, gums, or bone, ask if he can show you pictures so you can see what he’s talking about. Ask your dentist to explain your x-rays and don’t be afraid to ask about options and consequences of waiting. The more educated you can become about your oral health, the more you will understand your financial investment, if you need to make one. And the less painful that will be!
Purchasing dental benefits is almost like investing in your own health savings plan. It only makes sense if you will use it, and it has a lot of limitations. If investing in yourself with a dental plan will help keep you on track with your oral health, then I encourage it! If you only plan to go to the dentist when you are in pain or have an emergency, you will find your plan is sorely disappointing and you will not receive the value from it. However, if you are in good oral health, you may decide to simply pay your dentist out of pocket for your two visits per year. Just make sure you put a little money away each month (just like you would be paying your premiums) and you can insure yourself. Yes, if you need a root canal, crown, or implant, the price-tag can seem steep, but if you are taking care of your dental needs regularly, it will be a rare event and your dentist will likely have financial options to make your treatment affordable.
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