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Dental Insurance Is Not Really Insurance

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While 23% of all Americans have no dental benefit coverage, over 250 million people in the United States have some sort of dental benefit plan. Most people are covered by employer – sponsored plans and there are also those covered under Medicare, Medicaid and other government or non-profit programs.

While most people think of their dental plan as a dental ‘insurance’ plan, in reality it is not insurance at all.

Insurance is defined as a transfer of insurable risk between the insurance company and the covered individual. In the medical market, individuals pay a monthly premium and are covered by insurance when they are sick – and the insurance pays for all procedures to restore them back to their optimal health when possible. If you have medical insurance and suffer an attack of appendicitis, the insurance will provide for the exam, the surgery if necessary, the hospital stay and recovery. It will also cover the additional follow up care by the physician.

However, in the dental market, most dental plans are not ‘insurance’…meaning, the coverage does not insure the person will have their oral health restored or repaired.

Dental ‘insurance’ is actually a defined benefit contract between the employer (or individual) and the insurance company to help defray the cost of dental treatment. The contract is issued in exchange for a monthly premium. The contract has the following elements:

  • The contract defines what will be paid for each procedure but NOT what CAN be performed to achieve optimal dental health
  • The contract states the limitations of the coverage
  • The contract states which procedures are covered
  • The contract spells out the financial rules

Typically, a dental plan will cover preventive services such as cleaning and exams a couple of times per year. The plan will also define which dental procedures are covered, such as fillings, or a crown/bridge, or implants, etc. Each procedure has a financial limitation or rule associated with it..such as a maximum payment for a filling, or implant. Other financial rules consist of deductibles and copays, and maximum coverage limits.

One good way to cover additional dental expenses is to put away extra money into a Health Savings Account, known as an HSA.

We now know that having good oral hygiene is imperative for your overall health. There has been much research into the oral / systemic health link and it is a fact that periodontal disease contribute to heart disease, alzheimers, diabetes and more.

Don’t neglect your oral health and be sure to check your dental benefit plan to find out your specific coverage for various procedures.

Richard Murdoch, DDS has two offices in metro Denver and serves the neighborhoods of Glendale, Denver, Littleton, Centennial and Greenwood Village. You can reach us at 303-355-6340 or www.murdochdds.com

July 31, 2019