In the past, dental insurance was considered a luxury that only wealthy people could afford. Today most people believe they need dental insurance. Businesses commonly offer dental insurance in their benefits packages, and individuals often buy their own.
Medical insurance policies have a long and colorful history, but dental insurance only came about in the mid-1950s.
It is amazing to note that the first dental plans from 70 years ago were almost exactly like the plans available today. Typically, they paid 100% for preventative care, 80% for minor care, and 50% for major work. The maximum they would pay out over the course of a year was $1000. Surprisingly, most plans available today have the same benefits.
About the only thing that changed over the years with regard to this dental insurance is the new idea of in-network providers versus out-of-network providers. This was a great financial arrangement for the insurance companies. Dentists signed on to become “preferred providers” so they could get more patients.
A preferred provider dentist would reduce their fees and agree to accept whatever this dental insurance paid. If the patient chose to go to an out-of-network dentist, then the patient would have to pay the difference in price. This of course encouraged the patient to choose a dentist who was in their network.
However, these days dentists are dropping out of the networks. They have found that they cannot financially survive on the lower payments received from the dental insurance company.
The Future
A new trend is developing in dental insurance. Some medical insurance plans are beginning to offer dental as part of their medical plan.
In some ways, this seems inevitable. For example, when a patient has to have extensive dental surgery oftentimes the dental insurance would not cover it and would tell the patient that the services needed to be billed under their major medical policy.
Bundling the two policies will certainly be convenient for patients, but will have a terrible effect on stand-alone dental insurance companies. In the future, they will have to either join up with a major medical insurance company or find another way to be profitable like offering vision care or hearing benefits.
Strangely enough, dental insurance companies see less demand for dental care going forward. It is understandable that fewer people are seeing the dentist right now because of Covid-19, but studies show that younger people tend to see the dentist less frequently.
Insurance researchers feel this is due to the availability of better oral health care products in stores. Also, putting fluoride in water systems has been going on for generations now and the positive effects are showing up in fewer cavities and therefore less need for fillings.
In addition, many younger people pay more attention to their health overall which translates to better oral hygiene habits.
The future of dental insurance remains cloudy. Patients want the convenience of having their dental insurance as part of their medical plan. Dentists want insurance that will pay them properly. It remains to be seen which way the industry will go.
Cost-Benefit Analysis
But the core question remains: Is it worth it to spend the money on dental insurance?
If a person was lucky enough to have been born with good teeth and maintains excellent oral hygiene habits, dental insurance might cost more than a person can get back in benefits.
The average cost of this dental insurance across the United States is about $360 per year. If a patient only uses two cleanings at $80 per cleaning, obviously that patient loses money.
A lot depends on the cost of services in the area. If someone needs a root canal and a crown, the insurance will only pay 50% of that cost and the patient is responsible for the rest.
Also, figure in the fact that the policy probably has a limit of $1000. This means that once the policy pays out $1000, the rest is paid by the patient.
Based on this analysis, dental insurance does not make financial sense. It’s hard to make a case for buying it. If the patient knows they need major work done, the insurance will only cover $1000 of it, so the patient is only reaping a few hundred dollars in benefit. On the other hand, if the patient has good teeth and doesn’t need work, they won’t even use up the $360 they paid in premiums.
Pros
Even though it probably won’t be cost-effective, there are some good reasons to buy dental insurance anyway.
Dentists will be the first to tell patients that seeing the dentist regularly can prevent major problems later on. That way the patient is saving money in a round-about way. The ability to avoid a root canal because the cavity was found early is almost worth more than money.
Also, dentists are well aware that people skip the dentist because they believe they can’t afford it. Most people don’t know the cost of dental services in their area.
If a patient has insurance, he will be more likely to see the dentist if he has a minor problem. With no insurance, he might just ignore it until the pain gets worse.
Again, seeing the dentist early because they have insurance, might save people money in the long run.
An interesting reason to get dental insurance in spite of the cost is that many diseases of the body can show up in a person’s mouth.
A dentist might be able to diagnose diabetes because the patient has bad breath that won’t go away and his gums are inflamed. Following up with a medical doctor, a patient might be surprised to learn he has diabetes. And it was caught earlier because he went to the dentist. Dentists know that loose teeth and bleeding gums are warning signs of diabetes.
Dentists can also spot when a young person has an eating disorder like bulimia. The stomach acids hitting the teeth during all that vomiting erodes the insides of the front teeth.
With women particularly, dental X-rays using new software can detect early bone loss and tell the woman to follow up with their doctors regarding osteoporosis. Osteoporosis doesn’t damage the teeth, but it does damage the bones that support the teeth. Osteoporosis will show up as receding gum lines, and loose teeth.
When a dentist sees a patient with a dry mouth it might confirm a diagnosis of Parkinson’s disease. Although dry mouth has many causes such as medications, yeast infections in the mouth, snoring, mouth breathing, and even HIV, it is also a known side effect of Parkinson’s.
Dry mouth is also a symptom of drug abuse. Methamphetamines are known to cause severe dry mouth.
Periodontal Disease
This concept of spotting diseases through dental exams shows another possible upside to having dental insurance: disease prevention.
Since having dental insurance encourages people to see their dentist more frequently, the dentist can warn the patient about the possibility that their dental issues might cause other diseases.
When a patient presents with gum disease, the dentist can help the patient understand that the bacteria living under the gums can move to other parts of the body and cause diseases.
The newest theory on dementia states that the bacteria from periodontal disease can travel to the brain and contribute to dementia.
Heart doctors have long known that the bacteria from gum inflammation migrates to the heart muscle and causes heart disease or makes it worse.
