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Dental Insurance – Portland & Gorham Maine

A few words about dental insurance.

Do you have dental insurance or wish you did?  Are you considering buying an individual policy, or your employer’s plan?  Are you worried because you don’t have dental insurance?  If ‘yes’ to any of these it is important that you understand a few things about dental insurance, which is very different than medical insurance.

So, the first thing you to know, if you’ve always assumed dental is just like medical insurance, is:  it isn’t.

The Number One difference is that medical insurance usually covers, almost without limit, both routine services like doctor visits, and major services like surgery and hospital stays.

But dental insurance is designed to limit your coverage for major services; it only covers a very modest maximum amount, typically $1000-1500 per year.  And while many medical policies have low or no co-pays, dental insurance usually involves substantial co-pays for any services beyond cleanings and x-rays; typically amounting to over half of the total cost.  Even when the policy says it covers 80% of a service, the fine print says the 80% is based on a fee the insurance company determines, not the actual fee charged.  So your net co-pay ends up more, often a lot more, than the 20% you would expect.

In order to have a low priced policy to sell individuals as well as groups, the insurance companies are offering more PPO plans.  These plans are not new and are similar to what has already been described, but in a PPO the dentist must sign the insurance company’s ‘preferred provider’ contract in order for the patient to receive benefits.  In the contract, the insurance company gets the right to set all the fees (actually they set the maximum allowed, but rarely is the dentist’s fee as low as the insurance company’s maximum).   Of course, the insurance company is motivated to set fees as low as possible in order to price it’s product low and keep profits high.

While the PPO structure seems like it would be a win for the consumer, there are several aspects of it that should make you question whether it is actually something you want.   The contract favors insurance company profits but puts the dentist in a very precarious position:  he/she is legally responsible and accountable for the quality of care, but now loses the ability to charge a fee to cover increasing overhead costs or the higher cost of more complicated care.   This may mean the dentist has to make a choice between doing a procedure at a financial loss, or taking shortcuts to keep from losing.

An illustration of this is a policy that won’t pay more for a 4- or 5- surface filling than for a 3-surface filling.  Without a long detailed explanation of the difference between a 5- and a 3-surface filling, common sense tells you the 5-surface filling will take more time and material than a 3-surface.  In fact, a 5-surface filling can take more than twice as much time and material.  If you had that insurance policy, you would have to trust your dentist to do the additional work without being paid for it; and continue to do that even as expenses increase and payments fail to increase or even go down, as has happened with some insurance policies recently.

The dirty little not-so-secret about any and all insurance is this:  it is always set up so that over time the insurance company wins and you lose.  If that weren’t true, the insurance company would be broke and out of business.  But in the case of medical insurance, the potential loss covered could be catastrophic for you, if you had to pay it.  So to not have medical insurance wouldn’t be wise.  By now you can see that dental insurance is different, though.

Using average numbers for an individual dental policy you can buy today; the insurance is only going to help with your dental costs to the tune of $1000 a year and will cost about $50 a month or $600 a year.  With these numbers, that would mean you would only be insuring a possible $400 net loss in a given year.  Kind of like buying auto insurance for $600 a year that will only cover replacement of your bumper if you total your car.

So how did dental insurance ever get so popular?  Starting in the 1970s until only recently, dental insurance was sold only to large employers who insure many people as a single group.  The employer pays for some or all of the premium, so the employee never sees the actual cost of coverage, so it seems like a very good deal to the insured.  After all, when is free not a good deal?   The employers probably know that the cost of insurance is more than the amount of dentistry actually provided, but they needed to offer a dental insurance benefit to attract the best employees in a competitive market.

Fast forward to the 2010s:  the employment market is no longer so competitive, unemployment is high, benefits have been lost or reduced, plus the Boomer generation is retiring often without dental insurance.  So now suddenly, many people who once had paid dental insurance find themselves without, and they are feeling insecure.

Many who have lost their dental insurance simply stop going to the dentist thinking they will never be able to afford what their insurance has always paid for.  Many others look to buying an individual policy.  But in many or most cases they don’t understand the cost-benefit structure of these policies.  If that’s you, let us look at the policy you are considering and help you decide if it will benefit you.

The above may seem to paint perhaps a negative picture of dental insurance as a whole.  But that is not our intent.  Rather, it is to give you a realistic view of what dental insurance will and won’t do, so you can be a wise consumer and you won’t be disappointed by expecting more of an insurance plan than it is designed to deliver.

If you still have dental insurance paid by your employer, you have a real and valuable benefit if you use it to get regular care and maintenance.  If your employer is switching to a lower cost PPO plan (hint: if it restricts your choice of a dentist, it is a PPO), look carefully at all your options.  We recommend you do whatever you can to influence your employer to select a plan that retains your choice of dentist.  Many plans function as a PPO plan, yet allow you to choose a dentist ‘out of network’, meaning one that doesn’t sign the PPO contract.  If you are given a list of ‘preferred providers’, find out if you can choose a dentist off that list.

You won’t find us on any of those lists because at Morgan Dental care, we no longer sign contracts with insurance companies. Past experience has shown us that a contract like the PPO contract gives the insurance company too much control of your dental care, and has caused a variety of problems that can compromise quality.

If you don’t have dental insurance, or you determine you are paying more for it than it is worth, then we at Morgan Dental Care can help.  We don’t sell or promote any dental insurance plan, but we do have a membership plan, designed primarily for those who don’t have insurance.  It enables people to save money on dental care by reducing the cost of us delivering the care.  We merely pass the savings back to you. The membership fee covers all of your regular preventive care (cleanings, x-rays, fluoride treatments) at a total cost less than those same services would cost at regular fees, and pays benefits or fee reductions on all other services.

You can find all the details here: Denvantage, Dental Health Advantage Program