In some ways medical and dental insurance operate similarly, but many people don’t take the time to read in to their dental plans, or even have a proper understanding of what their insurance provides (or often more importantly, what they don’t provide). In this month long series, we will be posting an article per week about dental insurance to help you become more informed about this under-utilized benefit.
Dental care is often not placed into the same category as medical care in the average person’s mind, meaning that it is often considered beneficial but not necessary. As we have mentioned in previous posts, maintaining your dental health can improve your overall health so attending routine visits at your dentist office can really make you, or keep you, healthier.
We are going to start off with the basics: what dental insurance is and where it originated. Most people have dental insurance as a voluntary benefit option offered by their employers. If you decide to enroll, you will pay a monthly premium (some of which may be covered by your employer) and will receive benefits as negotiated by your employer and the insurance company. You may have different tiers of coverage to choose from, or there may be one standard plan.
If your employer does not offer dental insurance, you are self-employed, or you are retired, you may purchase individual dental insurance. These plans often have more restrictions than the employer-sponsored plans due to your decreased bargaining power. Additionally, under the Affordable Care Act (ACA), dental services are considered an essential health benefit for children under the age of 19 so if your child is not covered by a stand-alone dental benefits plan, dental coverage must be provided to them through their medical health plan (but again, on a limited scale).
Unlike medical insurance which was first offered in 1850, coverage for dental procedures is a relatively new benefit; the first plan was introduced in California in 1954! The plans gained popularity and by the 1970s they were everywhere, with the majority being offered by Delta Dental. At that time, coverage amounts were similar and the average annual maximum was $1000 – which unfortunately has not changed in the last 45 years. It seems that dental insurance companies are not keen on keeping up with inflation. In the beginning, there was no concept of in- or out-of-network providers and the fees paid were based on ‘usual and customary’ rates for a given area. This determination of rates still hold true, but vary depending on your network status.
Join us next week when we go further into the details of the types of dental insurance, how they are categorized and what those categories mean for you and for your dentist, as well as what in- and out-of-network means.