For many families, dental insurance – or any insurance coverage – can be confusing. Our family received new medical insurance cards a few weeks ago, and I had the pleasure of reading through my benefits booklet for our family’s new plan. It made me realize the significant differences between medical and dental insurance. Knowing how dental insurance works can be an empowering step as a patient when trying to achieve comprehensive health and wellness. For simplicity’s sake, I will speak in terms of generalities.
How does dental insurance work?
Unlike medical insurance, dental insurance typically has a low (usually <$50) deductible. Many plans waive the deductible on preventative procedures such as cleanings, exams and routine radiographs. Most dental insurance plans have a maximum they will pay out each year, usually $1000-1500 per patient. Once the dental insurance company has paid this maximum amount, they will no longer pay for further treatment and the patient pays for treatment until the new plan year. This differs from your medical insurance where there is typically not a maximum they will pay out in a given plan year once the deductible has been satisfied.
Dental insurance emphasizes preventative procedures.
We see many patients that haven’t used their dental insurance in years because they think they need to bundle a lot of dental treatment together to maximize the benefits from their dental insurance. What often happens in this case is that the patient will need a significant amount of treatment, well over their dental insurance maximum for the year. The patient then ends up paying out of pocket for a majority of the dental work, or worse, the patient delays treatment.
In short, dental insurance is less of an insurance and more of a yearly “use it or lose it” account. My recommendation? Use it to catch dental issues while they are small, inexpensive, and covered by your insurance.
What if I don’t have dental insurance?
No worries! It’s important to remember that you are paying for dental care whether you pay out of pocket at the dental office, or you pay out of your paycheck for a dental insurance premium. Many patients feel that they are not able to receive preventative dental care due to the cost; however, budgeting what would have otherwise been spent on monthly premiums can get you a long way. Don’t forget that your health savings (HSA) or FSA (flexible spending) accounts can be used at the dentist as well.
I encourage you to resolve to be an informed patient and consumer in order to break down any financial barriers you may have to receiving dental health care. Reach out and ask questions of your insurance company or broker, your dental provider and your financial advisor.
By prioritizing preventative dental care in your overall health routine, you can rest assured knowing that you are doing all you can to keep your expenses low in the long-term.
Mark Scallon, DDS