It will be beyond the scope of this article to provide the origin of dental insurance in the United States. We can presume that as long as mankind has been eating, he or she has at one time or another experienced a painful issue with their teeth.
How dental remedies were administered is subject to our collective imaginations. The lore of western movies would allow us to imagine the town doctor, or dentist if they specialized, administering a half bottle of whisky to the patient and then proceeding to yank an errant tooth out by the roots with a tool fashioned by the village blacksmith.
Of course, some have seen the child with a tooth tied to a door knob by a string and moments later, the door slamming shut removing the tooth before a protest could be heard. Some reading this may have been that child. Finally, if the history of dentistry were not demonstrated enough we have the image of Tom Hanks in his role in the movie Castaway. In that scene we see an ice skate blade lodged against the disturbed tooth and then pounded with a rock to dislodge it.
Developments in today’s dentistry should make us all thankful for the advancements that have taken place. From wellness visits with flavored pastes in lime, cinnamon or strawberry. Painless root canals due to local anesthesia and digital X-rays, allowing the dentist instant, pinpoint accuracy in assessing a problem, the field provides help and solutions to everyday citizens that would have commanded a king’s ransom in the time of Cleopatra.
As the art form has increased and developed to make the practice of dentistry a modern marvel, so too is the means to pay for these twenty-first century services. In the western frontier, the doctor may have received a chicken or freshly killed game as payment in exchange for his service. Today, the compensation function many of us use is our dental insurance plan.
The discussion we are in does not question the value of dental services we receive. We are a fortunate people living in the United States at this time, and having the care available to us that we do. Remember, there are people in the world whose dental care is like that enacted by Mr. Hanks in his movie. What we are considering now is if dental insurance is worth the cost?
There are two sources for dental coverage that we may 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 do not stare a gift horse in the mouth, as the saying goes. The second means of obtaining coverage is to buy a plan outright, paying monthly premiums. Here, consideration of value paid for value received is in question.
The prices estimated will generally be valid for most states with exception for New York, California, Washington D.C. and a few others where the cost for services are above the national average.
There are two basic types of reimbursement for dental coverage. Defined benefit and indemnity. In the first, the defined benefit form states that an exact dollar amount be paid for a specific procedure. An example would be $80 for a cavity filling. Todays reimbursement rate for the procedure is $80 and if the policy is not changed it will be $80 ten years from now.
The indemnity method will reimburse based on a percentage basis. The percentage may vary depending on the company but could range between 60% and 100%. These are general statements and the coverage will vary by state and company. Both methods, Defined and Indemnity, may utilize a small deductible as well.
In the long term there are advantages to both plans. The Defined Benefit plan would likely have a fixed, stable premium over the years as the payment for a service would stay the same. The Indemnity product would be expected to increase in cost because, as service costs increase, the percentage payment would also increase requiring a higher premium. A percentage of a larger number is a larger number.
Conversely, the Defined Benefit plan will pay a smaller percentage of the total cost over time if the service costs do rise, and they likely will. The Indemnity plan, as a percentage, will continue to pay larger benefits under the same conditions. The larger number theory again.
The remaining issue for value is the cost of the coverage and the benefit. On average, an individual at 40 years of age would pay about $400 per year. The benefit limit would be about $1000 per year. Preventive wellness benefits, a cleaning or a cleaning plus X-ray would be allowed immediately upon enrollment. A waiting period of six months would be expected before having available basic services, sealants, fillings and extractions. A waiting period of one year is usually required before major services such as crowns, bridges, dentures or root canals can be provided.
The $400 per year premium could easily pay for preventive wellness benefits twice a year. Remember, that all charges for service go toward the $1000 limit. The decision to pay $400 to get an additional $600 back would depend on an individuals needs. Some people have many dental issues, sometimes through heredity and the costs are justified because they know they will use the coverage. Others may like the peace of mind. Speaking for myself, spending 40 cents to get a dollar back is not a ratio that translates into a good insurance value.