Addressing the elephant in the room: Dental Insurance and The Problems it Can Cause

I am frequently asked if dental insurance is worthwhile.  The short answer is dental insurance can be very limiting.  It is a good supplement to help pay for your dental care if your premiums are low.  It is not great, however, if you expect it to pay for all of your treatment.  Let’s unpack this further – Dental Insurance and the problems it can cause.

Dental insurance is purposefully confusing.  Every day I see patients who feel frustrated about the strict limitations imposed by their dental insurance. Sometimes the treatment they need is only partially covered by their insurance or not covered at all.  Finding out the specifics of your coverage is a convoluted process and often without clear answers.  

In all honesty, dental insurance frustrates dentists as much as it frustrates our patients.  Dental insurance limits what procedures a dentist can perform.  These forces treatment decisions that might not be ideal for your situation.  You end up with treatment being driven by your policy and not your needs.  

In other words, the insurance company dictates your treatment, not you or the dentist you trust.

Dental Insurance And The Problems It Can Cause

Dental insurance is a bit unique in the insurance world.  Nearly all other types of insurance base their business model around the concept that a significant percentage of their policyholders will never use their full benefit.  The less people use their benefits, the more profitable the insurance company is.  Dental insurance is different, in that nearly everyone uses most or all of their annual policy allowance.  To remain highly profitable, insurance companies must severely limit their benefits.  

For example, when dental insurance first started in the early 1970s, many plans had an annual maximum benefit of $1000.  In 1970, that $1000 would cover the cost for a lot of treatment.  In 2020, the annual maximum benefit of most plans is still only $1000.  Although the cost for everything has increased dramatically over the last 50 years, this maximum benefit has not.  In addition, every year, insurance companies add more and more limitations to their coverage.  Dental insurance is getting worse as time progresses.

Dental insurance behaves differently than medical insurance.  Nearly everyone needs dental care.  At the very least, they need their routine cleaning and hygiene appointment twice a year.  This is why even healthy individuals use their dental policy allowance every year.

This does not hold true for medical insurance.  Many who are young and healthy often skip their annual medical exams and do not utilize much, if any, of their annual benefits.  They are mainly insuring themselves against catastrophic events.  

Put another way, dental insurance isn’t truly insurance in the same way as homeowners or automobile accident insurance. For example, most policyholders with fire insurance do not experience a house fire in any given year. The risk is spread among all the policyholders, so the insurance company can afford to cover the losses. With dental insurance, most policyholders use their insurance payout every year.

The Dental Insurance Trap

Unfortunately, I see many patients get stuck in the dental insurance “hamster wheel.”  When dental insurance is perceived as a necessity, patients without coverage tend to avoid preventive dental care.  Over time, small and inexpensive problems turn into large and expensive ones.  

For example, if a small cavity is detected during a routine exam, the cost of repairing it might be a few hundred dollars.  If that cavity is ignored, it grows larger and larger.   Sooner or later, the cavity must be addressed because of pain or swelling.  Now the size of the cavity requires root canal treatment and a crown, or worse, extraction and implant.  The delay in treatment can quickly increase the cost of treatment from hundreds of dollars to thousands of dollars.  

A similar type of situation can also happen when patients finally get dental insurance after many years.  These new policyholders are sitting on years of unmet treatment needs.  The annual maximum benefits are quickly used up.  Naturally, the patient would like to wait until the annual benefits reset the next year so that they can maximize their plan.  During that time, however, the small problems have time to grow into bigger problems.  Additionally, new problems can develop in that time.  In essence, patients never get “caught up.”  The limits of their plan can in no way cover the needs of their care.  

Regular preventive dental care, cleanings, and X-rays are essential to your overall health.  Dental insurance is a great supplement to help pay for these services.  If your dental needs extend beyond this, there is a good chance that your dental care will require more out-of-pocket expenses.  

Another limitation of dental insurance is that it restricts which dentists you can see.  Dentists who are passionate about quality care are dropping insurance plans in droves.  With the low reimbursement rates, they are finding it difficult to get the best training, the latest technology, or to spend time with the patients they care for.   

Why is Dental Care So Expensive?

Patients often ask why the cost of dental care is so high, and by extension, the cost of their dental insurance is also high. Here are a few things to consider:

• Dentistry requires a great deal of one on one time with the dentist and the patient.  If you think about it, dentistry is customized hand-made work done exclusively for you.  It requires both a scientific understanding and an artistic talent to perform well.  There is no good way to mass-produce dentistry.
• Dental overhead and administration costs are high. Rent, supplies, staffing, and purchasing state-of-the-art equipment are quite expensive.  Furthermore, dental insurance, in general, drives up healthcare costs by adding a layer of administrative costs in working with insurance providers.
• Becoming a dentist requires a lot of time and expense.  After an undergraduate degree, an additional 4-8 years of post-graduate training is required.  Dentists often graduate with $500,000 or more in student loan debt.  This does not include the costs of buying a practice or even starting a family.  Additionally, dentists invest thousands and thousands of dollars a year in Continuing Education so that they can provide the best care for their patients. 

Dental health is an important component of your overall health.  Regular preventive care and managing problems early are key in keeping your costs low.  Dental insurance can be an effective way to manage these costs.  Dental insurance does come with severe limitations. Learn about dental insurance and the problems it can cause in depth.  If your dental needs are more extensive, out-of-pocket costs will likely be required.  I tell my patients that they are often better served if they save a little each month in a Health Savings Account.  When larger needs and expenses arise, they can be more easily managed.  

If you want or need a high level of endodontic care, contact Lowry Endodontics today. If you have questions about whether your insurance covers your root canal, we are glad to help you navigate the process.