What is Dental Insurance?

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  • Written By: Michael Pollick
  • Edited By: Niki Foster
  • Last Modified Date: 30 April 2020
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Dental insurance is offered by insurance brokers to cover routine, and in some cases not so routine, dental work. Dentistry services covered by a typical dental insurance policy may include cleanings, fillings and crowns, emergency tooth replacements, non-cosmetic oral surgeries and x-rays. The term 'dental insurance' can be a bit of a misnomer, however. In today's world of managed health care plans, dental insurance agencies tend to call their plans PPOs (preferred provider organizations) or HMOs (health management organizations). Dental insurance plans are less likely to offer 100% coverage for major dental procedures.

Group health insurance plans provided by employers may or may not include a dental insurance rider. Employees may have to ask for additional coverage or seek out independent dental insurance agencies. If dental insurance is provided, the employer can place restrictions on the types of dental services covered under the plan. A list of dentists participating in the group dental insurance plan is provided to employees. This is considered a 'preferred provider' arrangement, hence the common abbreviation PPO. A PPO dental insurance plan is preferred by dentists because the insurer pays at least 80% on most claims. Routine dental visits may receive 100% reimbursement, while major oral surgeries and cosmetic procedures may reimburse the dentist 50%.

A less satisfactory option in dental insurance is the HMO plan. Under an HMO policy, the insurers can severely limit the amount of reimbursement to the dentist, but treatment cannot be denied to any eligible patient. Because dentists often have higher overhead costs than general care physicians, whatever expenses are reimbursed by an HMO insurer are lost in salaries, office rental, materials and other fixed costs. Fewer and fewer dental professionals are choosing to participate in HMO dental insurance plans as a result.

Dental insurance plans for individuals and families can cost as little as $80 dollars a year in premiums. Deductibles for dental insurance plans are usually negligible or non-existent. In essence, though, many of these lower-cost dental insurance plans work more like coupon books for future dental work. Even standard dental insurance coverage under a major medical plan can cap out at a paltry $1000 a year. One major dental procedure, such as a $3500 root canal, can easily surpass the coverage provided by traditional dental insurance.

Some employers provide a more informal arrangement for employee dental care. A certain percentage of the dental bill for routine visits may be reimbursed out-of-pocket by the company instead of filing a claim. Certain emergency dental procedures may also be covered under standard health plans, as long as they qualify as medical necessities. A child who loses a tooth in a bicycle crash, for example, may be covered if the emergency room physician calls in an oral surgeon to replace it. Otherwise, any non-emergency visit to a dentist would have to be paid out-of-pocket or through specific dental insurance claims.

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Post 2

@heavanet- I agree with you post and have similar experiences with my dental coverage. Without my dental insurance, I would have to pay much more for routine X-rays and cleanings each year. I found my plan by searching online, where the average person who does not have coverage through his employer can find affordable plan options.

Post 1

Though dental insurance does not go very far these days when it comes to paying for expensive dental procedures, everyone should have a plan. Without coverage, the cost of certain procedures can be too much for many people to afford. When compared to the affordable costs of premiums, most people actually save money each year with dental insurance coverage.

For example, I recently had several fillings replaced and the teeth covered with crowns. Though I had to pay $700, my cost would have been several thousand dollars without my dental insurance plan. Though I had to pay a lot to fix these teeth, I actually saved much more.

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