When most people hear the word “insurance,” they think of a safety net—something designed to cover significant costs in times of need. However, dental insurance works quite differently than other types of insurance, especially compared to medical insurance. In fact, calling it “insurance” may be misleading. Dental insurance is better understood as a “benefit plan” with limited annual assistance, and understanding this distinction can help you make the best decision for your oral health and finances.
It is very common for most patients to think of dental insurance as true insurance, when in fact that is just a marketing tactic from the insurance companies. Most dental insurances only serve to make money for their shareholders, and do more to harm the patient doctor relationship and erode trust.
1. Dental Insurance: A Yearly Maximum Benefit
Unlike medical insurance, which typically covers a large percentage of catastrophic expenses after meeting a deductible, dental insurance has an annual maximum. This maximum is the most that the plan will pay out over a year—often ranging from $1,000 to $2,000. This means that after a few treatments, or one extensive procedure, the entire benefit may be used up, leaving the rest of your dental care costs to be covered out-of-pocket.
This annual limit hasn’t increased much over the years, while dental costs have continued to rise, making the coverage less effective for those needing extensive dental care.
2. Coverage Restrictions and Exclusions
Dental insurance plans frequently come with a range of exclusions and limitations that can be surprising to those accustomed to medical insurance. Common restrictions include:
- Age Exclusions: Some plans restrict certain treatments based on age, covering procedures like orthodontics only for minors, or limiting certain preventive procedures.
- Missing Tooth Clause: If you had a tooth extracted before starting coverage, many dental plans won’t cover the cost of replacing it. This is known as the “missing tooth clause,” and it can be a frustrating surprise for those seeking restorative care.
- Waiting Periods: Dental insurance often comes with waiting periods for major procedures, meaning that you may need to wait anywhere from six to twelve months before coverage applies to services like crowns, root canals, or dentures.
These restrictions highlight that dental insurance isn’t designed to cover all your needs but rather to provide a basic level of support for routine care, often with minimal assistance for more complex work.
3. Cost vs. Benefit for Non-Employer Plans
For those who receive dental benefits through an employer, dental insurance may be a worthwhile addition. However, individuals buying plans independently may find that the costs of premiums and co-pays outweigh the benefits received. Monthly premiums, along with coverage gaps and annual maximums, can often result in a net loss, especially if major treatment is required.
In-house benefits plans: Here are Ortega Dental, we offer a way to have a “coverage” without utilizing a dental insurance company. We offer our Ortega Dental Health Club, which can serve as all the coverage you need for you basic treatment needs, without the hassle of a big corporation. Click here to learn more.