Public misunderstanding of dental insurance is widespread
Many Americans are surprised by how little their dental insurance covers when significant treatment is needed. A root canal and crown can cost around $3,000, yet a typical policy might only pay about a third of that amount. Experts note that many patients mistakenly believe dental coverage works like medical insurance, which is meant to protect against large, unexpected costs. In reality, dental insurance functions more like a discount program that helps defray routine care expenses but rarely pays the full price of major procedures.
Most plans cover 100% of preventive care such as cleanings and exams, about 80% of basic work such as fillings, and only 50% of major treatments such as crowns or bridges. They also impose annual maximums (e.g., paying only $1500 per year) and deductibles patients must meet before coverage begins. Once an annual limit is reached, any additional costs come entirely out of pocket, explains ADA spokesperson Sara Stuefen, D.D.S.
Dentists recommend several strategies to manage these costs. Patients can request a pretreatment estimate or prior authorization to anticipate out-of-pocket fees, though insurers may still adjust coverage afterward, Dr. Stuefen notes, adding that receiving preventive care, like regular cleanings, remains the most cost-effective way to avoid expensive procedures. Getting a second opinion or asking about staged treatments and payment plans can also help spread costs and prevent exceeding annual maximums.
While some professionals criticize dental insurance as outdated or even exploitative, others view it as a limited financial tool rather than true insurance. Ultimately, understanding coverage limits and asking informed questions are key to avoiding unwelcome financial surprises at the dentist.
Read More: New York Times (Paywall protected)
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