A question I have been asked more times than I can count is whether or not a patient should purchase dental insurance. When joining a group policy through an employer is an option, I find it is often worth the investment. However, when it comes to purchasing private individual policies on your own through an exchange or via an insurance broker or carrier, the needs of the individual create many challenges and the true value of the purchase isn’t as clearly obvious.
When searching for a dental policy, patients usually are looking to manage immediate dental needs which they know will be costly. The instinct to purchase dental insurance to cover those expenses is logical, but there are several problems which may arise when purchasing a policy expressly to cover expensive dental care in the near future. One of these is the so-called waiting period often implemented by the insurance company, as many an individual will look to purchase their coverage, exhaust the yearly maximum benefit quickly, then cancel the insurance policy. To curb this costly loss, dental insurance carriers frequently impose 6 month waiting periods on basic treatment (fillings, periodontal treatment, some surgeries) and 12 month waiting periods on major treatment (crowns, implants, bridges, dentures… you get the idea). Some policies have a 12 month wait for basic and major services, both. In my many years in dealing with financial arrangements and dental insurance coordinating, I have even seen policies which require a wait period before reimbursing on preventive treatment. One of my largest takeaways when searching plans is to ask about waiting periods, how long are they, and for what services will they affect. A similar hiccup to the waiting period involves missing teeth. Often called a “missing tooth clause”, this limitation will restrict the repayment of missing teeth such that any previously lost teeth will most likely not be covered for replacement. This is a problem for the many patients who seek to replace missing teeth via costly procedures such as implants and bridge work.
Dental insurance policies almost always have a maximum limit they will pay per year for claims. My earlier blog, Understanding Your Maximum, is a great resource on this topic. I can’t think of a policy individual or private, which has not had a maximum. Common amounts are $1000, $1500, and in some cases $2000 for the year. I have seen several individual policies with maximums as low as $500-750. Always ask how much coverage your plan will provide! If you need $5000 worth of dental treatment, and your monthly premiums add up to $500 a year, but your maximum benefit is $1000, you’ve only netted $500 in true benefits. Couple that with paying premiums for a waiting period on the services needed, and your benefit could be even less, plus delaying treatment during a waiting period never leads to a smaller cavity or an easier solution. Postponing treatment can lead to more issues which in turn increases your out of pocket costs. Always do the math to see if the benefits you’ll receive from the policy will actually benefit you. Sometimes it doesn’t pencil.
On top of policies requiring a waiting period or capping the amounts they will pay with a yearly maximum, I recommend checking to see if the policy limits the providers (dentist) you may see. There are policies that will only pay when seeing a doctor in their insurance network (contracted providers). Stepping outside of that often small network, sometimes labeled as an “exclusive” provider network, will result in the plan providing no benefit. Many policies do, however, allow for seeing providers out-of-network, but the reimbursement rate may be different (not always worse) than seeing a provider who is in-network. When you have a specific doctor or group you wish to see, always check to see if they are on your plan. If they aren’t, the policy can likely still be billed, but with the reimbursement at an out-of-network rate. When a policy is offered that sounds like a sweet deal with really low premiums and large maximums, always double check to be sure it provides coverage where you’d like to be seen. I don’t see how it makes much sense to pay for dental insurance if it won’t pay for who you want to see.
Another consideration when researching options are what exclusions may exist on the policy. If the plan you’re considering doesn’t cover implants, and you are looking to replace a lost tooth with an implant, that policy is obviously not going to help. Unfortunately, almost every policy I’ve ever reviewed considers some dental services to be “plan exclusions”, so be sure to ask what those may be as they vary from plan to plan. If you already have a treatment plan from your dentist – fantastic! Discuss the ADA codes on the plan with whoever is helping you purchase your policy to double check that those services won’t be denied when the claims are submitted. Often an insurance broker or company can provide a plan booklet which will allow you to review your benefits, covered services, and the “fine print” and exclusions which may exist in the policy. Read it carefully, and I can also be a resource for any questions you may have in regard to dental insurance coverage for your treatment plan with us.
Dr. White and many of his colleagues view the treatment they recommend and the planning they suggest with you, the person, in mind. Your dentist has countless hours of continuing education, practical experience, and a professional degree and license to practice dentistry. The insurance company does not, therefore, we work to practice and provide a high level of care without allowing dental insurance to dictate care.
In short, there are a lot of things to consider when searching for a dental insurance policy. As a patient and consumer, research as much as you can before your buy. Take a look at the cost of treatment needed versus the costs of the policy and do the math. It may become apparent that putting the funds to pay premiums away in a savings account would be a better solution, or you may find that insurance will be very helpful both now and in the future. Every case is different, so discuss your needs for the present and what is anticipated for the future with your carrier or broker and also your dental team. If you’re unsure of the best course of action, feel free to call me at White Dental Studio and I can help guide you through your decision. Ultimately, the decision is up to you, and it’s a big decision to make. I hope this blog has been helpful in answering whether purchasing dental insurance is right for you.