How Dental Insurance Is Like (And Not Like) Health Insurance

April 11, 2017

Insurance can be confusing. It’s like it has its own language. Sometimes, you don’t know why one treatment is covered and another is not. That’s true for both health and dental insurance. They two have a lot in common, but they are different. Dr. Miller, your Roseville, CA dentist, wants you to get the most you can from your dental insurance.

Call Advanced Dental Concepts today at 916-945-9985 to schedule your next appointment.

Why “Dental” Isn’t “Health”

The reason these two have separate insurance plans goes back to how dentistry was historically treated. For the last few centuries, dentistry was considered a craft like woodworking. It wasn’t about saving lives; it was about repairing teeth. That was a separate purpose than health, which focuses less on repairing and more on curing. (That’s why chiropractic care was not considered a real medical specialty for many years.) When insurance came about, it made sense at the time to keep health and dental separate.

These days, people know better. Dentistry is very much about your physical health. It can even help with your mental health by boosting your self-esteem and removing worry. These days, dental and health insurance share a lot in common.

How Dental Insurance Is Like Health Insurance

They typically have a deductible and coinsurance. A deductible is a dollar amount you must pay before insurance kicks in. If your deductible is $500 and you get $400 worth of treatment, you’ll have to pay all $400. Coinsurance is the percentage of the costs you’ll still have to pay. If a plan offers 80/20 for certain care, the insurance will pay 80 percent, and you’ll have to pay the remaining 20 percent. Deductibles and coinsurance are extremely common in both health and dental insurance plans.

They call doctors and dentists “providers.” It might sound weird to hear about “providers.” That’s just how both plans refer to people who give you medical or dental care. A list of providers is just a list of dentists, doctors, and other healthcare professionals. If they can provide you with care and bill your insurance, they are a provider.

They have benefit periods that may — or may not — coincide with the calendar year. This is a tricky one. Your benefit period is the length of this year’s insurance coverage. They are usually 12 months long. However, they do not have to be a calendar year. If you get insurance in November, the benefit period could end in October, not December when the year ends.

They can limit how often you get a particular treatment. Medical and dental insurance plans want you to get preventive care because that saves the companies money in the long run. However, both types of insurance will limit how much preventive care you can get. This is usually listed as so many times per benefit period.

They usually won’t cover elective treatments. Both plans are here to help keep you healthy. An elective treatment is one that you don’t need but want. Both plans normally will not cover such treatments since they’re not needed for your health. Cosmetic dentistry treatments are often considered elective, but something for sleep apnea could go either way with some plans.

How Dental Insurance Is Different

Dental insurance is more about regular care, not emergencies. Both kinds of plans encourage you to use preventive care. But health insurance is more about paying for unforeseen problems. Dental insurance is more about regular care and prevention.

With most cases, preventive dental care is free. In most health insurance plans, preventive care often still costs you. But with most dental plans, preventive care is often free. You have a limit, of course. You can’t get X-rays every month. But you can still get routine care like X-rays and cleanings without cost to you.

Health insurance is required under ACA; dental care is not. The Affordable Care Act made health insurance a requirement. If you do not have any, you have to pay more in taxes. That does not apply to dental care. If you don’t have any, you will not pay any kind of penalty. However, children are required to have dental insurance.

Call our Roseville, CA dental office today at 916-945-9985

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