Living Without Dental Insurance Coverage

It was in 1929 that the first iteration of modern health insurance was “born.” Justin Ford Kimball had created an insurance program for the school teachers of Dallas, Texas to great success, and the concept quickly spread across the world.

Today insurance is how the majority of Americans cover their medical costs. It has become so integral to our lives, many compare the benefits packages potential employers offer in addition to salary and commute time before accepting a new position.

Despite this, in 2015 almost 35%of American adults didn’t have dental insurance. And many in retirement are on a basic Medicare plan that doesn’t include dental coverage.

Even those who do have dental coverage find themselves forced into taking on loans to finance the dental care they need or—worse—putting it off for some indeterminable future date.

One thing is clear: Insurance is failing dental patients. Here are just a few of the ways.

Dental Insurance Policies Limit Treatment

Insurance forces patients to get the care they can afford instead of the care they need. They emphasize, and cover, preventive care leaving pricey, urgent procedures on the shoulders of the patient. This often forces patients into taking out loans to cover the cost or putting off tooth-saving, critical procedures entirely.

Many patients only get the care their insurance will cover through their plan—but with plans mostly covering only preventative measures, this leads to patients not getting the treatment they so desperately need in order to avoid out-of-pocket costs.

Basic procedures are often considered to be fillings, extractions, and periodontal work. While the insurance will only pay out half of the cost for more intensive procedures such as crowns, root canals, dentures, bridges, or implants. If at all. Some insurance policies do not cover this common dental work. Yet these procedures are crucial for maintaining oral health. They keep the patient out of pain and feeling confident in the appearance of their smile.

For example, a silver dental filling may be completely covered while a white dental filling is considered cosmetic and therefore only partially covered. In most cases, the more intensive the dental procedure, the less of the total cost is covered by a patient’s insurance plan.

Dental Insurance Fine Print

Many patients are often frustrated and feel as if they have been left high and dry when they discover the finer details of their dental insurance plan—especially when it comes to those pesky waiting periods.

Since it is so common for people to “save up” their dental problems until they get dental insurance, these companies have instituted “waiting periods” into the terms of their plans. This waiting period can be just a few months or stretch up to a full year before the cost of the much-needed procedures is covered. Usually the restorative, and costly, procedures that have initially led a patient to invest in a dental policy are subject to these wait periods.

Poor Oral Health Leads to Poor Overall Health

When it comes to insurance coverage, medical and dental care are separated—as if oral health is somehow independent of our overall health and wellness. But this just isn’t true.

The split between these two fields goes all the way back to when, centuries ago, you would visit your town barber or blacksmith to have your tooth removed. Historically, doctors have never dealt with oral health. This stands true even today despite our increasing knowledge of how closely the two are related.

Poor oral health is associated with heart disease, diabetes, osteoporosis, Alzheimer’s disease as well as low birth weight and shorter pregnancies.

In an extreme example, 12-year-old Deamonte Driver died in 2007 after a tooth infection spread to his brain. Deamonte didn’t receive the treatment he so critically needed due to the family’s Medicaid coverage having lapsed.

Lack of Dental Insurance Leads to Unnecessary Tooth Loss

Lack of coverage for critically necessary dental procedures leads to unnecessary tooth loss for many, many patients.

A patient might come in with pain, sensitivity, and swelling. While the tooth itself is in excellent health, the nerve below is compromised and requires a root canal to save the tooth. It’s all too common that the patient’s insurance doesn’t cover a root canal procedure—but it will cover having the tooth pulled.

If a patient can’t afford to pay for the cost of a root canal out of pocket they may opt to have the tooth removed in order to put an end to the pain they are experiencing.

This not only leads to the unnecessary removal of a healthy tooth, but it also creates a space in the patient’s bite that over time can lead to shifting of the teeth and malocclusion (misalignment of the teeth and jaw). Shifting and malocclusion can lead to pain and other dental issues.

Limited Savings

Insurance companies make their money by depending on those subscribers that invest in a plan but ultimately use very few of the benefits. Dental insurance benefits, however, are more often than not used to the maximum limit since oral health issues are so common. For this reason, dental insurance is not very profitable for these companies. This is why they drastically limit what is fully covered—usually just the two recommended yearly cleanings—and minimally cover pricier, but still critically needed restorative procedures.

In 1972, many dental insurance companies offered a $1,000 cap on their plans. And for the time, $1,000 would get you a lot of dental care—it would equate to a $10,000 max today. But today, the average cap on dental plans is still just $1,000 despite inflation and increase in procedure costs.

This maximum limit can quickly be reached today with just one major procedure. For example, an average crown costs around $900 and a dental implant $1,500 which is over the coverage limit for many plans. And while annual coverage caps have remained about the same from decade to decade, the cost of dental services has continued to rise.

To provide “full coverage,” an insurance company would have to charge more for premiums than a consumer would deem worth spending. So we get this hybrid “this is covered up to that amount/waiting periods/low maximums/no coverage at all” scenario that we’re in.

Healthcare economist, Dr. Adam Powell compares dental plans to getting AAA for your mouth. In an article on dental work and medical insurance for NBC he says, “It’s not like car insurance [which covers catastrophes], but it includes a few free oil changes.”

While oil changes and preventative dental care both help to maintain overall health neither can fully prevent serious issues from arising down the road.

So if you don’t have dental coverage or your coverage is insufficient for the work you need done, download information on our Smile Protection Program. We’ve got you covered.

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