• Dr. Greg Grobmyer

Is Dental Insurance Worth Having?

In this time of economic uncertainty, dental insurance seems like a good idea to most people seeking care. There are major misconceptions, however, about what dental insurance does and does not do. In fact, many people would be better off financially without the insurance! In this article, I will explore some of the misperceptions about dental insurance and hope to aid you in understanding it’s workings.

First off, few insurers work like medical insurance, in which you have a co pay and then most other expenses are covered. With dental insurance, different services are covered at different percentages based on how they are categorized into three distinct groupings, preventative, basic, and major. Preventative services usually include exams, x-rays, and basic cleanings. Coverage varies from plan to plan, but most insurance plans cover these services completely with no requirement to meet a deductible. Basic services usually include fillings, extractions, and minor restorative procedures, and the percent of coverage for these procedures normally falls around 70% – 80% after meeting some amount of deductible, often around $50. Once a deductible is met for a person, it is good for the rest of the calendar year. Crowns, dentures, and partials fall into the last category, called major. In an average policy, these procedures are only covered at 50%.

The next item differentiating dental from medical insurance is the individual yearly maximum. This is the most money a policy will pay out per person in a given calendar year. When dental insurance became popular back in the 1960’s, most policies had an average yearly maximum of $1000. Fifty years later, even with cost of living, material expense increases, and the value of the dollar being very different from 1960, the average yearly maximum is still $1000! After they have paid out this amount, regardless of how much treatment has been done, they will pay no more until the next year. If the money is not used, it is lost forever. This means that this is a great time to get work done here at the end of the year, as work can be spread out over two calendar years to double the available benefits.

Another misconception is that you have to go where your list of providers say you have to go. In the VAST majority of cases this is simply untrue. Most dental offices will file on almost any insurance, and very often, the patient’s payment percentages are exactly the same whether “in network” or “out of network”! Dentists who need more patients will agree to accepting lower reimbursement from the insurance companies in exchange for getting to “advertise” in the list of providers. This also often means the insurance company may dictate the quality of care you receive, requiring the dentist to use less expensive materials or limit the types of care they will be reimbursed for. For instance, if your doctor wishes to place tooth colored filling materials instead of silver amalgam fillings, which are cheaper and less reliable, the insurance company may alter their payment to cover the percentage of the cheaper alternative.

It also has to be said that dental offices are not responsible for what the insurance companies pay. A policy is a contract between the insurance company and the patient. Dentists usually file the claims for you as a courtesy. The ugly truth is that dental insurers are in the business of making as much money as possible. They do this by selling policies and not paying claims if they can get away with it. This makes for awkward moments for the dentist sometimes if the insurance company finds some loophole to not pay the claim the dentist expected them to cover. Please don’t get mad at the dental office! Get mad at the insurer! The dentist is usually willing to fight for whatever benefits they can get for you, but sometimes it is a losing battle.

Do the math and figure out if having insurance is to your benefit. Contact the dental office where you want to go and they should be happy to review your benefits and let you know what to expect, even if the office isn’t “on the list” of providers. Some people end up spending considerably more in premiums than they would ever get back in benefits. If you are just getting cleanings and checkups twice a year, with an occasional filling or something, you may be a lot better off without insurance, unless your company provides it for you. And above all, don’t let insurance dictate the quality of care you receive. You will be better off in the long run.

Greg Grobmyer


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