Dental Insurance at Southern Smiles
What is dental insurance, and how does it differ from a standard medical insurance plan?
Dental insurance is very different from medical insurance. Usually, it's much cheaper per month and has a maximum yearly benefit. For example, with medical insurance, you are typically responsible for paying up to a certain amount, say $2,000 or $10,000, depending on your plan. After that, the medical insurance company will cover everything else. If you need a major procedure, like open-heart surgery, you pay that $10,000, and the medical insurance covers the rest.
Dental insurance is almost the opposite. It usually covers up to $1,000, sometimes $2,000 a year, which is very limited. After that, you are on your own. The main difference is that dental insurance is cheaper, covers less, and can be seen more like a coupon code rather than true insurance.
How much is dental insurance on average, and what factors have an impact on the cost?
It really depends, but on average, employer-based dental insurance plans usually cost $20-$25 per paycheck on the lower end, maybe $60 on the higher end. It's not as much as medical insurance, and because of that, you can't expect it to cover as much. Factors that determine the monthly cost include the yearly maximum. Plans range from $1,000 to $2,500, with the best I've seen being $5,000.
A plan with a higher yearly maximum is better for you, but will probably be more expensive. Another aspect is whether it covers things beyond standard treatments, such as implants, braces, or Invisalign. A plan covering these will be more expensive. The type of plan, HMO or PPO, also affects cost. HMOs are often not as good as advertised, as they limit your choice of doctors and cover limited, lower-quality treatments. These plans are cheaper. In contrast, a PPO plan is more expensive but lets you choose your provider and covers higher-quality treatments like tooth-colored crowns or fillings.
Another factor is the presence of a waiting period or a missing tooth clause. Some not-so-great dental insurances require you to have them for six months before using them, or exclude coverage for treatments involving teeth missing before you got the insurance. So, be careful when picking an insurance plan.
What are the best dental insurance plans for major dental work or extensive procedures?
A frequent question is about the best dental insurance plans for someone needing extensive work or having a lot of needs. The answer is really none. As mentioned earlier, dental insurance plans are more like a coupon code, with a maximum benefit around $1,000, maybe $1,500 on most average plans. This was a great maximum back in 1970 when a crown cost a few hundred bucks. As costs have risen, those maximums have stayed the same. A good insurance plan might cover one or two crowns. If you have many needs, the best option is to skip dental insurance altogether and talk directly to your dentist. Many dentists offer a cheaper cash discount or better payment plans for uninsured patients. Many people today are fed up with insurance companies and choose to go directly to the provider, establishing a direct relationship without a middleman dictating terms.
How does dental insurance work for specific treatments like braces, root canals, or dental implants?
It depends on the insurance plan and the office. Some insurance plans will do everything they can to deny treatment approval, and after treatment, they may underpay. It also depends on the office. Some offices estimate costs, expecting insurance to pay half and you the other half. We don't like this method because if insurance underpays, we have to ask the patient for more money, which lacks transparency.
In our office, we tell the patient the full cost, expect full payment, and file claims on their behalf. The patient never gets a bill from us, only a check for what the insurance covers. We've found this to be more transparent, preventing surprise bills down the road.
Is dental insurance worth it for routine dental care and cleanings?
It really depends. If all you need is cleanings and you have a pristine dental situation, with good oral care and few fillings, it's up to you. Many dental offices offer savings plans, which are often better than dental insurance. You're paying the office directly, reducing costs. However, if your work pays for the dental plan and all you need is cleanings and the occasional filling, it's probably worth it.
What dental procedures are typically covered by medical insurance versus dental insurance?
Sometimes patients need sedation or large surgery that dental insurance won't cover, and they wonder if medical insurance could. The answer is usually no. Dental and medical billing are very different, and most dental offices can't bill medical insurance. Medical insurance companies usually deny these claims. However, they may cover cases where a child is born with genetic defects affecting their teeth or some sleep apnea-related situations. Generally, medical and dental insurances are two very different systems and don't interact.
Can you explain supplemental dental insurance and when someone might need it?
We're seeing these more frequently with the aging population on Medicare, which often lacks dental benefits. Patients buy additional coverage like Medicare Advantage or Dental Plus, which builds on Medicare and provides dental benefits. It can be a nice addition for those worried about significant needs, but these benefits often don't cover much, despite being sold as if they do.
If you're interested in getting insurance, it's a good idea to talk to your provider first. If you have a provider you're happy with, ensure they accept your insurance plan. Otherwise, you might be forced to find a new doctor, possibly of lower quality.
How should seniors choose the best dental insurance for their individual needs?
Seniors often ask how to choose the best dental insurance for their needs. It's worth having a conversation with your dentist first. Many dentists have in-office savings plans, like in-house dental insurance without the middlemen and large fees. If the dentist doesn't offer that or feels your needs are different, they might know a trusted broker selling good plans. Talk to your dentist; they can help assess your needs and guide your decision.
How can patients find affordable dental insurance that fits their needs?
We often get asked, "How can I find affordable dental insurance that fits my needs?" Dental insurance is generally not very expensive, averaging $20-$30 a month. Sometimes your employer might even pay for it. The real issue is what it covers and how much you'll still pay out of pocket. For those with significant needs, it's often better to go straight to the dentist. Find a practice focused on people without insurance or providing comprehensive, affordable care. Another option is to consult a trusted dentist who can help assess your needs and recommend a fitting plan. They may even know an insurance broker to connect you with. My best recommendation is to have someone help you figure out your needs when looking for affordable dental insurance.
Is it possible to have two dental insurance policies, and how does coordination of benefits work?
It's not common, but it happens when a patient still works with an employer offering a dental plan and starts having coverage through Medicare Advantage. It complicates things because there needs to be a primary and a secondary insurance. Patients often think having two plans will cover everything, but it can be the opposite. Insurance companies might pass the responsibility to each other, complicating things for the practice.
For most people, having two dental insurances is not as beneficial as they might think. If you have two plans because someone is paying for them, it's different, and the dental office can help. But generally, it's not worth the hassle.
If you live in or near Phoenix, AZ, and are looking for dental care, contact us at (480) 530-0755 to set an appointment. Our staff would love to talk with you!
