Dental vs. Medical Insurance

While they both share the same category, medical and dental insurance is really polar opposites of

each other. Medical insurance focuses on the aftermath of an injury or illness. With medical insurance, you are paying for something you hope you never have to use. Dental insurance is more focused on preventative maintenance. It encourages routine check-ups, cleanings, sealants, and fluoride treatments. Most dental insurance companies cover some if not all of these procedures and want to ensure their patients are healthy. Our office routinely fields questions about medical and dental insurance and have compiled a list of some of the most common questions. Jackson Family Dentistry is committed to your oral health and part of that is educating patients on various dental topics.

How Does Dental Insurance Work?

Dental insurance works off of a predetermined costs system. All costs have been negotiated for you by the insurance company, usually in conjunction with your employer. If a dentist accepts your insurance then they also have to accept the predetermined rates. Dental insurance also has a very low limit compared to medical insurance. Most plans have a $1000-$1500 cap and once you reach this limit, insurance companies will not pay anymore and you will be left to pay for additional dental work you receive until the next calendar year. Considering a crown can cost $1200, it is very easy to reach your maximum benefit. Insurance benefits also do not roll over to the next year. Therefore, if you need a procedure done, it is best to use your benefits because if you don’t you would have paid all year for insurance but would not receive any of the benefits from it.

What Is Covered By Insurance?

Dental insurance is typically covered using a 100-80-50 coverage system. Meaning for routine and diagnostic care, such as cleaning and exams, dental insurance will pay 100% of the cost. For basic procedures such as fillings and root canals, insurance will pay 80% of the cost. Finally, procedures that are lengthy and considered major such as crowns or bridges, insurance will pay 50%. However, in all three cases, insurance will only pay up to the policies cap limit. Meaning, even though insurance will cover 80% of a root canal, if the percentage goes over your policy limit, then they will only pay a percentage that equals the policy cap.

Does Dental Insurance Cover Pre-Existing Conditions?

Unlike medical insurance, dental insurance can sometimes cover pre-existing conditions, however, this does vary depending on which insurance company you have. There is generally a waiting period of 6-12 months, where even though you are paying to have insurance, you cannot use it until after your wait period is over. Some companies allow you to use it right away but the insurance benefits will usually be lower until after your wait period.

Does Medical Insurance Cover Any Dental Procedures?

Your medical insurance can cover some dental procedures if the procedure is deemed medically necessary. Medically necessary is typically defined as dental care arising from non-biting accidents. For example, your medical insurance might cover the cost of jaw reconstruction due to a car accident, or an infected wisdom tooth that could cause further medical problems.

Medical and dental insurance is very different from one another and knowing the differences will help you maximize your insurance benefit. Unlike other dental offices, we handle all of the insurance paperwork for you and file an insurance claim on your behalf. We understand going to the dentist can be a cumbersome endeavor and we want to make your visit as easy for you as possible.