Insurance is complicated, so let us highlight the key points for you so you can make an informed decision. First, it’s important and interesting to understand the history of dental care, and why dental and medical care are considered separate, even though both are essential for optimal wellness.
Research has demonstrated links between periodontal infections and chronic conditions like diabetes and cardiovascular disease. Studies have found associations between periodontitis and adverse pregnancy outcomes, such as premature labor and low birth weight. Tooth problems also hinder chewing and eating, affecting nutritional status. Eventually, poor prevention and treatment can become a medical problem — leading to serious health consequences.
So if dental health is so important to overall health, why isn’t dental care covered by medical insurance?
The split between the medical and dental professions has deep roots and history. For centuries, extracting teeth fell to tradespeople like barbers and blacksmiths – doctors didn’t concern themselves with such care. In the U.S., the rift between dentists and doctors was institutionalized in 1840 when the University of Maryland refused to add dental training and oral surgery to its medical school curriculum. This lead to the creation of the world’s first dental school.
Making sure you’re covered with a medical insurance policy is a good idea. Many people assume dental insurance works in the same way as medical insurance, but that’s not the case. Most dental plans come with a maximum annual benefit of between $1,000 and $2,000. This means once you’ve reached your coverage limit, any other expenses will be out of pocket. For routine maintenance like twice-yearly professional cleaning, exam, and x-rays, you may not reach this limit. But for other procedures like a dental crown or root canal, you’ll likely incur out of pocket costs. Medical insurance covers the cost of your bills after your deductible is met, which varies depending on your specific plan.
The Missing Tooth Clause
Another variant unique to dental insurance is the missing tooth clause. This means that the insurance company has a provision in their contract that states if you lost a tooth before the contract began, they don’t have to cover the cost of treatment. In some cases, this happens when your dentist has already done the work to extract the tooth and when a claim is filed for the treatment to replace the tooth, it’s denied. So now you’re left with a gap in your smile or a huge bill. Talk to your dental insurance company to determine if your plan has a missing tooth clause. If so, you can change your plan.
If you already had a tooth extracted and are waiting for restoration treatment, talk to your company about a predetermination, as defined by the American Dental Association, is an estimate of who pays for what on a particular service. At least you know what you are getting into and you can budget, save, or set up a payment plan. Some insurance companies will waive the clause if the tooth extraction occurred at about the same time as the policy began. Or if the extraction was within three years of the proposed replacement date. Some insurance plans will cover the restorative treatment after a specific waiting period.
We know this process can seem complicated and arduous to navigate. Whether you have dental insurance or not, we will work with you to find a solution so you get the care you need. In addition to working with insurance companies on your behalf, we offer special financing options so you never have to worry about continuing to live with a dental problem. We’re proud to offer our own in-house dental savings plan to make sure you get the care you need regardless of your insurance coverage.
What types of dental insurance plans can you choose from?
Rather than selecting from a list of in-network providers, this plan lets you pick your dentist and then pays a percentage of the dentists’ fee. The deductible may be lower than other plans and the annual maximum coverage limit may be higher. But the premiums may be higher than other plans, which means you’ll be paying your share of dental treatment fees upfront. This type of dental insurance plan is great if you have a particular dental provider you love and anticipate needing advanced, costly dental care.
Ranieu Dental sees the troubles our patients have with dental insurance or lack of it, and we want to provide a solution so you can get the care you need in a way that fits your family budget. Think of this as a dental savings plan. It’s not insurance, it’s better! You get the routine care you need and discounted rates on other services when you maintain your twice-yearly professional cleanings.
What You Get:
- 1 Annual dental exam
- 1 full mouth x-rays
- 1 emergency visit
- 2 hygiene cleanings each year
- 15-20% off additional dental work
- $1,000 off full treatment with Invisalign
- $325 Zoom whitening treatment
PLUS a special members-only discount on any needed treatment, including cosmetic services!
Even better, because our patient membership club is not insurance, there are:
- No deductibles
- No yearly maximum benefits
- No exclusions for cosmetic or elective care
- No waiting periods
- No spending limit
- And your benefits are activated the same day of purchase.
Family of 3
Family of 4
Pay upfront or over time and your entire family could be covered to get the care they need and discounts on treatments.
PPO or Preferred Provider Organization plans
When you visit an in-network dentist you pay lower fees for your care. The insurance network pays more for the treatment than they might with a fee-for-service plan or HMO plan. You don’t have to see in-network providers, but your portion of the treatment is less if you do. So if you see a dentist out of network, you’ll pay more out of pocket for treatment. PPO plans often come with a maximum amount they’ll reimburse in a calendar year. Some procedures may not be covered or have a waiting period before coverage starts. This plan is best if you don’t need major dental work right away and want to be prepared in case you do in the future and want flexibility in your choice of dentists.
HMO or Health Maintenance Organization plans
With an HMO, you’re required to see dental providers in the insurance network. Preventive services—cleanings and X-rays—will be 100 percent covered, while basic procedures come with a co-pay. You may not have a deductible or maximum annual limit and premium payments will likely be lower. But the plan may cover less than 50 percent for major restorative dental care. This plan is best if you don’t have a preference in the dentist and don’t anticipate needing any treatment other than preventive care.
The actual costs to you will vary depending on the plan you have and what treatment you need. In addition, treatment fees may vary from each practice and between cities and states. If you need more than basic care expect to pay out of pocket. Many patients decide to use the Ranieu Dental Savings Plan to ensure they get the care they need and discounts on more advanced treatments.
Use it or lose it
Whatever insurance plan you pick, it’s in your best interest to use what you have. Unused benefits will not roll over to the next year and will be lost. So if you’re paying for dental insurance make sure you maximize your benefits. Less than half of insured adults actually use their dental benefits even though about 47 percent of adults participate in employer-sponsored dental insurance plans.* Or, consider dropping your dental insurance and joining the Ranieu Dental savings plan so you never have to worry about the complicated world of dental insurance.
*According to a 2019 survey by the National Association of Dental Plans
Before picking a plan, ask yourself these questions.
- Which dental procedures am I likely to need this year? How much would they cost out of pocket? How much would they cost with insurance? Dental care fee varies by state, but you can use online tools to get an idea or talk to your dentist.
- How much will I pay monthly and annually in premiums?
- How much will I pay for professional hygiene cleanings without insurance? With insurance?
- What is the maximum annual payout for this insurance policy? Which procedures are covered?
- What types of dental care will others on my plan need?
If you have questions about your dental insurance plan and treatment or want more information about our dental savings plan, contact us today! We’re always happy to help you live your best life with a confident smile.