Crystal Lake, IL Dentist
77 E. Crystal Lake Avenue
Crystal Lake, IL 60014

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Posts for tag: Dental Insurance


We get asked, all the time, about dental insurance. And it's almost never an easy conversation.  Dental insurance typically isn't easy  for the patient AND the dentist. There's not enough coverage, too many things aren't covered at all, the co-pays are too high, and the limitations are fairly strict. But why is this so?  Well, there's really just one reason, in our opinion, and it's dental insurance is simply not profitable to insurance companies.

Dental insurance first started in the mid 60s/early 70's.  Dental insurance was offered with a $1,000 - $1,500 cap in 1972.  And $1,000 - $1,500 bought a lot of dental care in 1972.

Today, the average cap on dental plans is ... $1,000-$1,500.  Wait ... what? No, you read that right -- it's still $1,000 - $1,500 (on average).

So in over 40 years, the benefit has not gone up.   Insurance has raised caps on nearly everything except dental insurance. That should tell you something about the business model of dental insurance.

So why isn't offering "good" dental insurance profitable?  What's a reasonable "bad" scenario for dental work? $5,000 a year? How much premium are you willing to pay to protect against that?  Probably not much. We can assume because of a fairly low "worst case" dollar number, patients will not be willing to pay all that much for the premium.

In addition, the insurance company knows if they provide coverage, it will more than likely get used to a degree (at the very least for twice yearly cleanings/checkups, and yearly x-rays). So to make a profit, they have to charge more than what that will cost, and then also average out what will get used beyond that. Very, very quickly the premium cost will add up to where it's not really worth doing, because the worst case isn't "lose your shirt" territory.

To provide "full coverage," an insurance company would have to charge more for premiums than a consumer would deem worth spending. So we get this hybrid "this is covered up to that amount/waiting periods/low maximums/no coverage at all" scenario that we're in. Which really helps nobody -- insurance companies don't like it, dentists don't like it,  and worst of all, patients don't like it.

There are no easy answers. But at least now you sort of have an idea as to why dental insurance works the way it does.  

  • The "use" factor. In plain terms, dental insurance almost always gets used, oftentimes, right up to the max. This is not so with other types of insurance. In fact, the entire profit model of insurance is based on a certain percentage of people not using it.

  • Pre-existing conditions. Many dental problems are often ignored for years. So the feeling is that many people will "save up" their problems until they get dental insurance. This happens so often that many dental insurance providers have a waiting period of one year for any major work.  

  • Dental problems are more commonplace than many other health problems. There are very, very few people out there with no need for dental work at all. Almost all people with dental insurance will use it to a certain degree every year. Conversely, looking at typical health insurance as a comparison, a great number of healthy people will often go years without seeing a doctor.

  • The total cost of work is lower, making it difficult for an insurance company to charge a high enough rate to offset the "people using it" factor, but also for the rate to be low enough to be "worth it" to the typical consumer. Put another way, you have health insurance not only for routine doctor visits, but for "catastrophic" events. After all, an operation/hospital stay could bankrupt you. Thus, even at high premiums, health insurance is a must have for most people. Not so for dental insurance.