Dental Insurance Annual Maximum Benefits Explained

dental insurance claim form

This week, our Patient Care Coordinator wrote a piece about dental insurance benefits and the very low maximum set in place years ago, which is still the standard today. See what she had to say about insurance coverage and how we help patients receive the care they have had recommended when insurance only covers a small portion of their payment.

Dental insurance started in the late 1950’s, and the average maximum benefit was $1,000. This gave patients the ability to cover a good portion of their dental treatment with little out-of-pocket expense back then. That was over 60 years ago, and dental insurance maximums have still not increased more than marginally. Do you know why these numbers have not increased? Because less than 5% of patients who have insurance actually utilize it! It is supply and demand; if we aren’t showing insurance companies there is a need, they won’t increase maximums, because they don’t see why they should! Do you see the problem? Today, with most benefit maximums still around $1,000, on average, if you have a cleaning and x-rays, need a couple of fillings – maybe a crown, your total fee could easily surpass that!

 While this dinosaur of a figure, $1,000, has not changed, insurance premiums and dental fees are much higher than years before. Overhead has risen, materials have advanced (which makes them more costly), and the cost of living in general always rises. This outdated maximum benefit number does not take into account any of these advancements and changes.

 So what does this all mean? It means that dental insurance may have to be looked at as a supplement for financing your dental care. In many cases, we see everything covered at 100% but in other cases, dental insurance is not all-encompassing. It is great when used to help pay for routine preventive care like dental exams and hygiene visits, and often we find it helpful in paying for a portion of dental treatment fees, but sadly it is rare that we see it cover 100% of the cost of treatment. Now I plan to end my rant about the lack of full coverage by insurance companies and talk about how we can help make your dental care more affordable. However, for this you have to wait until next week, where we approach financial difficulties in dentistry with payments that make dollars and sense.