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Why Does Dental Insurance Cover So Little

Why Does Dental Insurance Cover So Little


You’ve just seen the dentist for the first time in a couple of years. Not to anyone’s surprise, you find out that you need a couple of fillings and a crown. You don’t floss, and you even enjoy a soda a couple of times a week. Over time, your teeth have taken the toll.

“I’m good,” you think to yourself, “after all, I have dental insurance.”

However, once you sit down with the treatment coordinator, you find out that your dental insurance doesn’t cover nearly as much of your care plan at all. In fact, it almost looks like you’re left paying for most of it out of pocket. 

Is Dental Insurance Just a Big Rip-Off? 

Having dental insurance is great when you don’t need a lot of treatment. Paying for a policy each month is enough to cover all of your preventive services (checkups and cleanings) and maybe a little more. So, if you need a filling or two, you can schedule the procedure without having to worry about going over your maximum allowable benefits for the year. A maximum allowable is a set dollar amount that your insurance will pay up to, but not over.

Keep in mind, you also have a deductible or co-pay that you need to cover out of pocket before your insurance will pay for a dental treatment. There’s a fine balance of math that needs to be done. For some people, having dental insurance can help them budget better and save a few hundred dollars a year, or at least get a discount on a filling every now and then. For others, it winds up costing more to have insurance because it doesn’t cover what they need it to. 

How to Know Which Dental Treatments Are (or Are Not) Covered by Insurance 

As a general rule, your dental treatments are categorized into a few different types of services, each under a different tier of coverage. Preventive services, like cleanings or exams, are typically covered at 100%. It’s when you go past preventive treatment that your insurance stops paying as much.

Basic or minor treatments like small fillings are partially covered (usually around 75-80%) but only after you’ve paid your deductible and any co-pays. However, if you have too many basic treatments that need to be completed, you may be at risk of going over your maximum allowable amount before everything is done.

Now let’s say you need major work, like a crown. The coverage on your dental policy drops even more, down to around 50%. If you need more than one tooth worked on, there’s a good chance that the additional teeth aren’t going to be covered, because you already maxed out on your benefits.

Finally, elective services such as dental veneers, teeth whitening, etc. are not ever covered by dental insurance. They’re considered cosmetic, so they aren’t medically necessary. 

“I Thought Dental Insurance Was Supposed to Cover Everything I Needed”

Depending on how you look at it, dental insurance does help cover everything that you need…but only if your needs aren’t very big. If you see the dentist regularly and treat tooth decay or dental problems when they’re small, you can get more out of your insurance coverage. It’s when problems get put off for a while or are very complex that most people find themselves having to pay out-of-pocket for a majority of their dental treatment.

Prevention is the best medicine…especially when it comes to your teeth. If you have dental insurance, take advantage of the preventive services coverage, so that you can save more money over the course of time. 

Money Saving Alternatives to Buying Dental Insurance

For people who need a lot of dental treatment but have limited coverage under their dental insurance plan, it may be better to enroll in a savings program. Discount dental plans apply a pre-negotiated discount to every treatment, regardless of how much or how expensive it is. Yes, that includes everything…whether it’s necessary or elective (like cosmetic treatments.) With no maximum allowables, waiting periods, or exclusions, a lot of people find discount dental plans to be more effective than traditional types of insurance.

Find out more about signing up for an affordable dental savings plan that covers what you need to keep your smile healthy. Contact the affordable dentistry experts at today.

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