Dental Insurance

What It Means

Dental insurance is a plan designed to make dental care more affordable. As with health insurance, most people with dental insurance enroll in a plan through their employer. Plans vary widely in covered procedures, which can range from routine maintenance to more complicated treatments, such as surgery. The three main types of dental insurance plans are indemnity, PPO, and HMO.

Indemnity plans were once the standard model for dental insurance. Today they tend to be the most expensive option. The patient can go to any dentist, and the insurer will cover either a set dollar amount or a certain percentage of the fee (typically 50 to 80 percent). In addition, the patient usually has to meet a deductible before the insurer will take over payments.

A form of insurance that is more popular is the dental PPO (preferred provider organization). By enrolling in this kind of plan, a person gains access to a network of approved providers. These are dentists and other dental-health professionals who have a contract with the insurer stating that they agree to give discounted rates to plan members; in return these providers receive a larger volume of patients. PPO members may also see providers who are not in the network, but patients who do this will be responsible for a larger portion of the fee.

Dental HMOs (health maintenance organizations), also called DHMOs, resemble the health insurance plans known as HMOs in that the member designates a primary-care dentist, who will then manage the patient’s access to specialists. DHMOs are usually the least expensive option, offering the lowest annual fees (called premiums) and the lowest out-of-pocket costs. With DHMOs patients will only be covered for treatments received from providers who are in the network.

When Did It Begin

Dental insurance emerged in the 1950s as a result of efforts on the part of longshoremen who worked the docks in California, Oregon, and Washington. Through union bargaining with management, these workers won coverage for hospital and surgical expenses. Wanting also to secure affordable dental care for the members’ children, the union in 1954 asked the Oregon Dental Association to come up with a program for such care. In response the association in the following year founded the Oregon Dental Service, which would administer prepaid dental programs for the union and other groups. The American Dental Association endorsed dental service corporations in 1957 and created an agency to oversee such corporations in 1965. In 1969 this agency was named the Delta Dental Plans Association. By 1978 it was supervising 44 dental service corporations nationwide.

In 1959 the Continental Casualty Company became the first commercial insurer to offer dental insurance. Over the following two decades membership in private dental insurance plans increased dramatically. One million Americans (0.5 percent of the population) had such dental insurance in 1962; by 1978 that number had increased to 60 million (27.3 percent of the population).

More Detailed Information

Dental insurance resembles health insurance in many ways, but it is fundamentally different in its emphasis on preventive care. Unlike most other kinds of illness and injury, dental-health problems are largely preventable. Preventive care (regular cleanings and checkups) ultimately keeps the cost of dental care low by reducing the need for more serious and expensive procedures. DHMOs thus encourage their subscribers to seek preventive care, usually by covering 100 percent of such procedures; some also cover sealants and fluoride treatments. As treatments become more complicated, the insurer covers a smaller percentage of the cost. For instance, it may only reimburse the patient for 50 percent of the cost of restorative procedures.

Nearly all dental insurance plans cover basic care, which includes cleanings and checkups (twice a year), X-rays to detect cavities (once a year), a complete X-ray survey (every three years), and cavity-preventing sealants for patients under the age of 18. More involved treatments, such as fillings, crowns, root canals, and dentures, may be partially covered or not covered at all. Some policies offer optional coverage for orthodontia (correcting tooth alignment with mechanisms such as braces). Dental insurance almost never covers cosmetic procedures, such as tooth whitening or porcelain veneers.

Dental insurance is usually completely separate from health insurance; often a person’s dental and health plans will be provided by two different companies. Sometimes (for instance, when surgery is required) it is not clear whether a situation is a medical emergency or a dental emergency. For this reason many health insurance contracts stipulate that they will not pay for any treatment associated with the teeth or gums.

Recent Trends

In 2000 the U.S. surgeon general released a report titled “Oral Health in America” that drew national attention to the issue of dental care as a public-health concern. The report argued that dental care should not be viewed as something separate from health care. For instance, it stated, dentists play an important role in early detection of disease (including HIV, cancer, and diabetes), and untreated dental problems can lead to serious health problems, such as heart infections, oral cancer, and pregnancy complications.

The report also included evidence that poor Americans have less access to dental care and as a result have more problems with oral disease. For instance, studies showed that more than 30 percent of poor children ages two through nine had cavities, but only 17.3 percent of children who were not poor did. The surgeon general also concluded that dental insurance was a significant factor in whether people received dental care. Studies showed that children from families without dental insurance were two and a half times less likely to see a dentist than were insured children, and uninsured children were three times more likely to have dental problems than were insured children.

The surgeon general’s recommendations for improving the situation included establishing outreach programs in communities with insufficient access to dental care, making dental insurance available to more Americans, and getting more dentists to participate in public health-insurance programs (such as Medicare) by offering them more competitive rates of reimbursement.