Dental Articles for Individuals

Dental Articles for Individuals

Insurance - The lottery you don't want to win

This is a simple phrase that explains the role of insurance in modern life.  Whether it is insurance that is mandatory, like auto insurance, or elective like dental it is important to understand why insurance is worthwhile, and how it works.

Let’s take auto insurance as an example of how insurance works.  Drivers have the same general risk, getting into a car accident.  The risks vary from a few hundred dollars for a “fender-bender” to millions due to injury.  While only a few of us will encounter the worst, we all want to be protected from that risk.

The insurance company determines that for every X number of people who pays insurance, one person will need to have coverage for the worst.  The money needed to pay for that person’s catastrophic accident, and smaller claims, is the largest part of your insurance premiums.  The rest of your premium goes to overhead costs, and keeps the insurance pool large enough to pay any claims.  For insurance to exist, more people must pay more than they will ever get back from a claim.  Considering what would need to happen for us to get our money back, most of us would consider that a lousy lottery to win.

Thankfully when it comes to dental insurance the same concepts apply, but the risks are considerably smaller.  Dental insurance plans also pay out less than what most people put in.  Only if you have serious dental work to be done can you expect to “get your money’s worth,” or get ahead at the end of the year.  But dental insurance does help spread the cost out over a year, and many plans save you money if you go to a network dentist (see also: PPO, HMO, DHMO).  With dental insurance most of us hope we never need to file that big claim, but it is important to know that if we need to it is there.

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Is there such a thing as full coverage dental insurance?

Is there such a thing as full coverage dental insurance?

This is a question we get quite often, and the short answer is no.  Dental insurance will not cover every procedure you will need at 100%.  Dental insurance is a tool to help protect you from extremely high dental bills, but even with the best coverage you will be paying something out of pocket.  Most dental insurance will cover preventive or routine work like cleanings and exams at 100%, but coverage for basic or major work will have some limitations.

The most comprehensive dental insurance on the market typically limits coverage for basic and major work in a couple ways.  First, most plans include a waiting period for basic and major services.  The waiting period is typically 12-18 months of coverage under the plan, although some procedures like fillings may only have a 6-9 month waiting period.  Spirit Dental has no waiting periods for Basic or Major Services.  Coverage starts as soon as your plan does!

The second way dental plans limit coverage is through the use of annual maximums.  An annual maximum is the maximum dollar amount an insurance plan will pay out for covered services per calendar year.  This is a real concern for those needing major work because many plans have a low limit, like $1000 or $1500.  If you happen to need a few thousand dollars of work, anything after that amount will not be covered.  Spirit Dental offers three different annual maximums, $1200, $2500 and $3500.

But the most important restriction most plans have is no coverage at all for some procedures.  Many dental plans on the market limit the number of procedures you can have in a period of time, like one crown every year.  Some dental plans will not cover crowns, implants, or orthodontia at all.  Details like this tend to be buried in the fine print, so it is important to look closely at what a plan covers before you decide to buy.  You don’t want to get a plan that does not cover implants or crowns when you know you may need one or both of them in the future.  We are happy to provide a Spirit Dental which does cover implants, crowns, and child orthodontia.

 

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