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Maximizing Your Dental Care and Understanding Dental Insurance

We all carry various forms of insurance, generally to avoid hefty out of pocket costs. Currently, health care law prohibits insurance companies from setting dollar limits for yearly or lifetime coverage for essential health benefits. Despite dental issues having the ability to cause pain, infection, affect chewing and thus nutrition, implications with other serious health conditions, as well as mental health, dental benefits for adults are absurdly considered “optional”.
Annual Maximums
Dental insurance companies definitely take advantage of this and in most cases set an annual maximum of $1,000-$2,000, and have not changed that for about five decades. $1,000 in 1973 had the same buying power as $7,022.77 in 2023. A dental crown even on the low end is over $1,000 using in-office fees. Some doctors take a lower rate to be in-network with insurance, but it would still be at least several hundred dollars. Exams and cleanings are also counted towards that $1,000-$2,000. So even though you might be paying zero at those visits, insurance is paying something, which will reduce your remaining benefits by that amount. This means it is very possible to eat up your entire year’s coverage with one treatment need.
Denials, Limitations, and Exclusions
Dental insurance companies are very good at making their plans look appealing by having simple breakdowns, which usually say something like: “Diagnostic and Preventive: 100%, Basic: 80%, Major: 50%”. But when you consider that they only provide that up to your annual maximum, not so good. Add that they can deny any treatment they determine as “unnecessary”… Considering that dental benefits for adults altogether are considered “optional”, it should not surprise you that insurance companies deny coverage all too-often.
Other ways they avoid payments are with waiting periods, provisions for preexisting conditions, and senseless rules. Example: “The Limited Oral Evaluation Benefit is payable only for visits where no other covered services are performed.” I.e., with this plan you can go in for an exam for a problem, but if you want it covered, you cannot have treatment the same day.
Key Takeaways
In some cases you may actually spend more on your premium than you would have spent out of pocket going to the dentist, particularly if you only require preventive care. Some dental offices offer their own savings options, which are definitely worth considering in place of dental insurance. Many times these are more transparent, and you don’t have to deal with a third party in the middle of your care. If you are using dental insurance, it is best to think of it more like a coupon. Use it for a little savings when it applies, but don’t let it dictate whether or not to complete a treatment or whether or not to start or stop seeing a dentist you trust and are comfortable with. Particularly if you have more extensive treatment needs, dental insurance coverage will usually max out early into your care.
If you have any questions, please feel free to contact our office at 830.357.7177 or You can also follow us on Instagram, Facebook, and TikTok for dental tips and updates and find FAQs and more info at