Facts you should know
About dental insurance
As an optimum-care dental specialty practice, we want to share some facts about dental insurance so you can make informed choices.
Fact 01
Your dental insurance is based on a contract between you, your employer, and a specified insurance company. For questions about your benefits, it’s best to contact your employer or insurance company directly.
Fact 02
Dental benefits differ greatly from general health benefits. In 1971 your dental benefit was about $1,000 per year — decades later it’s often still $1,000. At 6% inflation you’d expect roughly $5,000 today. Premiums rose, benefits didn’t. Dental insurance is never a pay-all; it’s only an aid.
Fact 03
You may be told fees are “higher than usual and customary.” An insurer surveys an area, takes 80% of an average that includes discount clinics and managed-care facilities, and calls it customary. A specialist in private practice will naturally have fees above that figure.
Fact 04
Many plans say they cover “up to 80% or 100%” without specifying the fee schedule, annual maximum, or limitations. It’s more realistic to expect coverage of 35%–65% of major services. What a plan pays reflects how much the employer put in, less the insurer’s profit.
Fact 05
Insurance companies do not cover many routine dental services.