It will be beyond the scope of this article to provide the origin of dental insurance in the United States. We can assume that while mankind has been eating, he or she has at one time or another experienced a painful problem with the teeth.
How dental remedies were administered is subject to our collective imagination. Western movie lore would allow us to imagine the town doctor, or dentist if they specialize, administering half a bottle of whiskey to the patient and then proceeding to pull out an errant tooth by the root with a tool designed by the town blacksmith.
Of course, some have seen the boy with a tooth tied to the doorknob with string and moments later, the door slammed shut, knocking the tooth out before a protest was heard. Someone who read this may have been that child. Finally, if the history of dentistry wasn’t proven enough, we have the image of Tom Hanks playing him in the movie. Discard. In that scene we see an ice skate blade lodged against the affected tooth and then hit with a rock to dislodge it.
Advances in dentistry today should make us feel grateful for the advances that have occurred. From wellness visits with lime, cinnamon or strawberry flavored pastries. Painless root canals thanks to local anesthesia and digital X-rays, allowing the dentist instant and pinpoint accuracy in assessing a problem, the field provides help and solutions to ordinary citizens who would have demanded the rescue of a king at the time of Cleopatra.
As the art form has risen and developed to make the practice of dentistry a modern marvel, so too have the means of paying for these 21st century services. On the western frontier, the doctor may have received a freshly killed chicken or prey as payment for his service. Today, the compensation feature that many of us use is our dental insurance plan.
The discussion we are in does not question the value of the dental services we receive. We are a lucky people living in the United States right now and we have the care available to us that we do. Remember, there are people in the world whose dental care is like that portrayed by Mr. Hanks in his movie. What we are considering now is whether dental insurance is worth it.
There are two sources of dental coverage that we can access. The first, and most common, is a plan offered through or provided by an employer. If someone is going to pay for the coverage, don’t look a gift horse in the mouth, as the saying goes. The second means of obtaining coverage is to purchase a plan outright, paying monthly premiums. Here the consideration of the value paid for the value received is questioned.
The estimated prices will generally be valid for most states with the exception of New York, California, Washington DC and a few others where the cost of services is above the national average.
There are two basic types of reimbursement for dental coverage. Defined benefit and compensation. In the first, the defined benefit formulary states that an exact dollar amount is paid for a specific procedure. An example would be $80 for a cavity fill. The current reimbursement rate for the procedure is $80 and, if the policy is not changed, will be $80 ten years from now.
The compensation method will reimburse based on a percentage. The percentage can vary depending on the company but could range between 60% and 100%. These are general statements and coverage will vary by state and carrier. Both the Defined and Indemnity methods may also use a small deductible.
In the long term there are advantages to both plans. The defined benefit plan would probably have a fixed and stable premium over the years, since the payment for a service would remain the same. The Indemnity product would be expected to increase in cost because, as service costs increase, the percentage payout would also increase, requiring a higher premium. A percentage of a larger number is a larger number.
In contrast, the defined benefit plan will pay a smaller percentage of the total cost over time if service costs increase, and they likely will. The compensation plan, as a percentage, will continue to pay higher benefits under the same conditions. The theory of the largest numbers again.
The remaining issue for value is the cost of coverage and the benefit. On average, a 40-year-old would pay around $400 per year. The benefit limit would be approximately $1,000 per year. Preventive wellness benefits, a cleaning or cleaning plus x-ray would be allowed immediately upon enrollment. A waiting period of six months would be expected before becoming available essential services, sealants, fillings and extractions. A one-year waiting period is generally required before major Services such as crowns, bridges, dentures, or root canals may be provided.
The $400 per year premium could easily pay for preventive wellness benefits twice a year. Remember, all service charges go toward the $1,000 limit. The decision to pay $400 to recover an additional $600 would depend on the needs of each individual. Some people have a lot of dental problems, sometimes through heredity, and the costs are justified because they know they will use the coverage. Others may like the quiet. Speaking for myself, spending 40 cents to get a dollar back is not a ratio that translates into good insurance value.
