Happy New Year! With the New Year brings new dental insurance plans, and confusion about what does dental insurance cover. So I thought I would start addressing a few of these items in our new blog! If there are topics you would like us to write about or if you have any questions, feel free to contact us at firstname.lastname@example.org. In this first blog, I am going to try and compare Medical and Dental insurance plans.
Before I begin, however, I will let you know a little about me. I have been managing dental offices for 18 years. I am an accountant by education and married into the family business. My husband and I thought we would work together briefly when we started the Val Verde Dental practice in LaVista, and here we are 18 years later! So, here are a few disclaimers I need to throw in. First, I know absolutely nothing about your personal insurance policy other than what is on your insurance card, and we have very little access to the details of your plan. You, as the policy holder have way more access to your policy details than we do. There are thousands of different plans out there with different clauses and exclusions, so, make sure you research your own policy for specifics. What one policy may cover, other policies do not. We work tirelessly every day to try and estimate what your insurance company will pay and what they won’t, but sometimes it is like trying to look into a magic ball that just doesn’t work. We recommend dentistry based on what we believe is in the patient’s best interest, not based on what insurance is going to cover.
So here we go. First let’s dive into medical insurance because it is what most people understand a little better. Then I will show you how dental insurance is basically the OPPOSITE of medical insurance. Yep, opposite.
Most medical policies have two numbers you should know. First number is your deductible. The second number you should know is your “max out-of-pocket”. So with medical policies, you have to pay for medical visits out-of-pocket until you have met your deductible, and then medical policies start to cover a percentage until you reach your maximum out-of-pocket. I know many medical policies also have co-pays, so a doctor’s visit might be $50-$100 instead of going towards deductible, but generically speaking, you pay your deductible and a co-pay before insurance kicks in. With medical insurance the insurance companies make their money up-front before they start paying a substantial amount. However, depending on the extent of an illness or injury, their portion can be high. Therefore, medical insurance is typically a lot more expensive than dental insurance. This is a VERY simplistic explanation of how medical insurance works in an attempt to try and show how dental insurance is the opposite.
Moving on to dental insurance. Typical dental insurance plans have a MAXIMUM benefit for the year of $1,000-$2,000. I have been working with dental insurance for almost 20 years and these maximum benefits have not increased. From what I understand, these maximum benefit amounts have not changed in 50 years. Can you think of anything that still costs the same as it did 50 years ago?
Typically dental insurance will pay 100% or close to for very minimal preventative treatment. They then pay 50-80% of some treatment until they have paid out the maximum benefit allowed. After they have paid their maximums, the remainder of the year is the patient’s responsibility. Dental insurance really is just a benefit to help pay for minimal dental treatment and covers very little beyond preventative dentistry. Now, the cost of dental insurance is typically much less than medical insurance because the dental insurance company’s risk is very low and risk is the name of the game for insurance companies. Remember the phrase, “you get what you pay for”, is true and most insurance companies are for-profit businesses. If you are paying in $240 per year, they probably are not going to pay out $10,000 in that same year for dental care. It doesn’t make good business sense to do so.
Unfortunately, insurance companies have contributed to the need for expensive dental treatment by dictating how often patients are seen by their dentist. Preventative dentistry can be VERY effective in helping minimize long-term expenses, but many people believe because dental insurance pays for typically two “cleanings” per year that is all they need.
Please remember, insurance companies are not concerned with your health. It isn’t their purpose. They provide a product. A very finite product intended to make money. So the moral of the story today is just because it “isn’t covered by your insurance” does not mean it isn’t necessary. We recommend what we recommend based on your health and well-being, not based on your insurance coverage.