You have Dental Care Medical Insurance? , you must know it

I think there is no insurance company that will cover “complete” dental care at 100% with no maximum limit. (if you are not eligible for government plans like Medicaid/Medicare) While medical insurance covers all costs beyond a certain amount, dental insurance is better considered as a discount plan. The best coverage will likely be with a PPO (preferred provider) type plan with a dentist who is in that insurance in-network. Most plans will have a waiting period so you can’t just rush to the dentist and have full benefits the day you sign up. Many plans will have an annual co-payment (usually 50$) toward major work (fillings, crowns, etc.) Every plan I have ever seen has had an annual maximum (typically $1000–$2500) which is the most a carrier will ever pay during their specific time of coverage toward your dental health.


Most plans only cover a percentage of work (discount plans) Typically 50–100% of work is covered and you are responsible for the remaining amount. Many plans do not cover specific elective or cosmetic procedures at all (implants and cosmetic dentistry). Many plans will not pay if they disagree with a diagnosis.

Many plans will “downcode” procedures and only reimburse for the cheaper of two treatment options. For example, you wanted a white filling on a tooth that shows in your smile and white fillings are typically more expensive than silver fillings so if you insurance contract includes provisions for downcoding they will only pay for the silver filling leaving you responsible for the price difference. As you can see this gets extremely confusing and is, in my opinion, the primary source of frustration patients have in modern dental practices. To make things worse most patients believe that dental insurance companies have their best interests in mind. Unfortunately, this is not the case.You have to remember that insurance companies are businesses that have to turn a profit to remain afloat. If they covered “comprehensive care” they could not turn a profit as Dental Caries (cavities) is the most ubiquitous disease in existence. Many dental offices will help you understand your insurance so you have an idea what will be covered prior to scheduling any treatment.

The safest way to be 100% sure what you will be responsible for is to have a “pre-authorized” treatment. Basically, the dental office contacts your insurance and “pretends” to bill out work. The insurance company will respond with an “estimate” of your responsibility (in 2–3 weeks). My advice would be to see a dentist for an exam/cleaning to get an idea of your needs and get estimation of bill also. If you are a graduate student you may have a dental school connected to your institution or nearby that can provide expertly supervised care at a much-reduced cost. If it looks like your dental needs are extensive, it might pay off to consider joining a dental insurance plan. However, if you have never had a cavity and it looks like you will just need a cleaning and minor work for the foreseeable future you’re probably better off just paying cash for your dental expenses.

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