Organization of this Chapter

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Example Insurance Plan

Dental Decisions directed by Insurance Policy

Bottom Line for Dental Insurance


Dental Insurance: Basics

What is the best dental insurance to have? Not to sound facetious, but the best insurance is a good savings account. An IRA, or a home-equity line of credit will do as well.

There are well respected insurers out there that will cover dental work, but never forget that insurance is above all a business!

The insurance company owes their stockholders that they will not pay out more than they take in. Now, of course, someone else will pay in what you use beyond what you pay in – but it is a gamble for both you and the company.


Example Insurance Plan

Consider for example a company that has three plans available to you. For one you pay $75 per month, for the next it is $50 per month, and for the last it is only $25 per month. You need to look pretty carefully at what YOU get for each of these plans.

For the first two plans, you can select any licensed dentist you want, but they are bound by the restrictions of your policy. These are PPO, preferred provider option plans.

The procedures that are covered are not so important, because they are not FULLY covered. There are two ways they do this – first, they have a percentage of the practitioners fee that they will cover, AND there is a maximum per year that they will pay you for everything all added up. AND – for major insurance companies in the dental industry, they will have a maximum fee schedule for the dentist that does provide service to you, so if the dentist you select has really high fees, the insurance will pay a percentage of the maximum.

For example – you need a crown. IF the plan you have selected covers crowns, and the dentist you choose has a fee that is acceptable to the insurance company, they will pay a percentage of that fee to the dentist. Let’s say the price the dentist charges is $1500, and that is within the acceptable range for the company. The plan you have selected will pay for a crown, but only for 50% of the fee. So they will pay the dentist $750 for the crown and you must come up with the rest out of your pocket. Oh, and there may be a co-pay as well, maybe $40.

If your dentist tells you that you need a crown, you may think to get insurance to cover part of the cost – but the plan you have selected, specifically for expensive procedures, like crowns and implants, will only pay for such after a certain period, say one year, after you start paying on the insurance.

Now, in the case above, you have been paying $75 per month for the plan for 12 months – for a total of $900. For that they give you back $750 and you pay another $750 to the dentist.

Of course, there is a maximum that they will pay per year as well, so let’s say that is $1500. So, at least you have another $750 from which they will cover parts of other procedures. If you need fillings, they may pay up to 80% for those, and if the cost of a filling you need is $320, that is another $256 from you remaining coverage for the year.


Dental Decisions Directed by Insurance Policy

Because of the constraints on what the insurance company will cover, you may want to direct a little differently what dentistry is done.

If you can restore a tooth with a large amalgam restoration rather than a crown, it would be much to your financial advantage.

If you can have a large anterior composite restoration done instead of a crown, that would be much to your advantage.

If your dentist recommends “deep cleaning” for a high fee, I would question that, based on discussions we’ve had in other parts of this site.

Another of the decisions that you need to make, depending on the insurance plan you have signed up with, is which dentist you will get to do the work! The more you pay per month, the more dentists will be in the network that are close to you, and many of these will be private dentists with small practices.

The reason I emphasized small practices in the last paragraph, is that they are more likely to be able to alter their plan to meet your needs, rather than a dentist working in a large clinic.

Large dental insurance companies will also have participating dentists that CONTRACT with the company to provide services at a greatly reduced rate. They may call this a DHMO, dental health maintenance organization, or something else. These may well be FIXED RATES, because they have been agreed between the dentist and company. The participating dentist has agreed to accept a greatly reduced payment, and your portion of the cost of a crown may be as little as $400, instead of $750. And, there may be no maximum per year, and no waiting period. But, you have much less choice about the dental office you agree to go to.

You may only find one participating office in your area, and they may have many dentists that are mostly production oriented – the more they get done each day the happier the owner of the office will be.

On the other hand, you may find participating dentists that have been in business for a long time and don’t feel the financial constraints that a younger dentist may feel.


The Bottom Line for Dental Insurance Selection

Read the fine print!

And look around!

Look for the answers to the questions I posed above and see if the plan is worth-while for you. If you anticipate a lot of dental work coming up soon, AND you can find a participating dental office that you like – it seems all of the staff are working efficiently and are not stressed – then that kind of plan is a good option.