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Should my health insurance company cover dental work?

man and woman in office seek dental health insurancePerhaps your health insurance company should cover dental work, but they usually will not. A routine dental exam or procedure might uncover other medical issues that would be covered under the terms of most health insurance policies. Since the inception of health insurance, during the latter part of the nineteenth century, most common dental services are not covered.

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In comparison to health insurance, dental coverage is a rather recent invention, dating back only to the 1960s. Health insurance can trace its roots back to the 1850s and 1860s as Mutual Assurance Associations (early precursors to trade unions) were formed to provide support and help protect employees in certain trades and businesses, such as railroad and shipyard workers.

These associations banded together to form the first insurance companies in the US, among the oldest, is the Travelers Insurance Group, which began in 1860. The first insurance policies protected workers from accidents or injuries suffered on the job, paying out cash to cover living expenses and to replace lost wages.

Gradually, over the last half of the nineteenth century, the benefits of these early accident policies expanded, first providing liability or disability coverage and finally covering medical issues other than those that were caused by accidents.

When was the first health insurance policy written?

The first employer based group health program was written in 1911, just over 100 years ago.

In the 1920s and 1930s, individual hospitals became involved in protecting the citizens of the communities they served, writing the first “hospitalization” plans and forming organizations that later evolved into the “Blues,” groups like Blue Cross and Blue Shield, that still account for a large portion of health coverage across the nation.

Why is dental insurance different?

Today’s dental “insurance” coverage is different from the HMO (health maintenance organization) and PPO, (preferred provider organization) plans that cover the medical expenses of most Americans. Health coverage options, as we know them, are descendants of traditional health and accident and liability insurance policies.

The demands for dental coverage came about much later and developed for very different reasons. Most dental plans are “discount service” programs, meaning that you, the subscriber, pay less for covered services based on a pre-established schedule. Generally, the insurance company or plan originator doesn’t pay out any money, to you or your dentist.

Who benefits from this kind of service?

In reality, the middleman, or in this case the insurance company stands to gain the most from a discount service relationship. The insurance company signs up various dental practices, who agree to reduce their rates in exchange for a steady stream of new patients.

Over the years, dental practices have become larger and larger, owing at least in part to the tremendous expenses involved in setting up a dental practice. Individual dentists can no longer afford to practice alone. Groups are forced to seek a greater volume of customers to cover their overhead, which often is as high as 70% of gross receipts.

What is usually covered by dental insurance?

Dental discounts generally apply to prophylactic or preventive treatments, such as routine examinations and cleaning. One or two exams per year may be covered. Basic x-rays are also covered, though more complicated services such as fillings or root canals are only partially discounted.

Usually, only small fractional discounts are allowed against expensive dental procedures, such as a crown or oral surgery. For instance, a crown might cost $1100 or $1200, while a typical dental plan would provide only a $200 or $300 discount. Essentially, the dentist is willing to give free cleanings for the promise of more costly future procedures.

Is dental coverage expensive?

No! But then again, dental plans don’t cover treatment or services in full, as health insurance policies will. Plans often start as low as $75 or $80 per year for a single individual, with family plans available for as little as $150 per year.

Where can I find dental plans in my area?

Since dental insurance is a very profitable product for insurance companies, the marketplace in recent years has become flooded with offers. Informed consumers will always want to check out the competition before selecting and purchasing a dental plan. National member organizations such as the AARP  often recommend insurance programs to their members.

The American Dental Association can also provide helpful information and put you in contact with dental practitioners in your area. As with any other form of insurance, programs, policies and benefits may vary widely from state to state.

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