July 18, 2013

How Does Dental Insurance Work?

The other day a patient was in for a visit and told us she was not going to have dental insurance coverage after December.  She and her spouse had assumed that they would research dental insurance coverage to replace what they presently had.  I offered them the free service that we provide at Tavormina Dentistry of reviewing any research they came up with and evaluating the information for the best coverage, as well as evaluating for any savings by not replacing the dental benefit.

It’s important to remember that dental insurance is not an insurance, but a benefit.  The difference is that for most dental plans, there is a limit to the total amount that the insurance will pay out per year.  The dental benefits vary based on the plan the employer or privately insured person has agreed upon with the insurance company.  Most dental plans don’t reimburse for services more than $1,000 maximum per person per year.  This was a pretty good amount in 1969 when dental “insurance” came into existence, but in 2013, unfortunately, $1,000 coverage doesn’t go very far, especially if the patient with the dental benefit has significant dental needs.

On the other hand, if a patient visits the dentist regularly, and does his own homecare well, they most likely only have the fees for regular routine maintenance.  Very often the fees that a dental office charges for routine prevention, diagnosis, and cleanings can be less than the premiums for, let’s say $1,000 coverage.  So, if you only need routine care, it may make more sense to use your money to cover the routine care, especially if the premium for a limited dental benefit is greater than the fees for these services.

Having a dental benefit is most useful when you do have need for additional dental services in Millburn NJ and when there is an employer in the picture paying the dental insurance premium.  In most cases dental coverage for prevention, diagnosis, and cleanings is covered in full or almost completely by the dental benefit, and should make it very easy for people to receive routine health maintenance visits twice a year, which is the usual limit for such care for most dental insurance plans.  Although most adults ideally benefit most by checkups and cleanings every 3 months (based on scientific research), when people have dental benefits, they usually find they are only covered for two such visits.  Some coverage is better than none.  Don’t let your coverage dictate how frequently you have preventive/hygiene visits.  There are many different kinds of plans, so what is covered, and when, varies.

The best advice we can give is that if you are interested in having dental benefits, make sure you have the freedom to choose to see whatever dentist you want, and still receive your dental benefit.  You want to choose your dentist, not have the insurance company choose your dentist for you.

For information about other dental topics visit www.DrTav.com


  1. Is there any method we should use to know the exact amount of money to invest in dental insurance?

    William Martin

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  2. Please tell me something about dental insurance. What are the benefits of dental insurance?
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  3. Does tooth extraction covered with the insurance? I wast just wondering because a friend of mine pays professional fee to the dentist when she undergo tooth extraction even if she has dental insurance?

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