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Is Dental Insurance Separate From Health Insurance

Dental Insurance Is Like Triple A For Your Mouth

What Dual Coverage in Dental Insurance Means

Now, lets say you do have dental insurance. Thats certainly more favorable than the alternative, but its hardly ideal. If you undergo a serious procedure, youll likely still be left with a hefty bill.

Dental insurance, unlike medical, is not regulated and it tends to be very constrained, says Powell. The annual maximum benefit is not that high, and theres usually some sort of deductible.

And its a relatively new type of insurance, with Dr. Bobbi Stanley, a dentist, noting that it was first introduced some 60 years ago. Dental work was a fee for service agreement until the mid-50s when dental insurance was introduced in California, says Dr. Stanley. rose in popularity throughout the 60s and had a reimbursement of about $1000.

Inflation may have catapulted the worth of the dollar over the decades, but the reimbursement rate for dental insurance hasnt budged much. Most dental insurance companies have an maximum of $1,500.00, says Dr. Anil Dwivedi, a general dentist with a specialty in anesthesiology.

Clearly the purpose of dental insurance is not to cover dire issues, but to prevent them by encouraging regular maintenance. Dr. Powell likens dental plans to Triple A for your mouth,” highlighting that “it’s not like car insurance , but it includes a few free oil changes.

Dr. Powell asserts that one major reason dental plans tend to be so minimal in what they cover, is because people dont want to shell out higher premiums.

Dental Coverage Is Available 2 Ways

  • Health plans with dental coverage: Some Marketplace health plans have dental coverage. You can see which plans include dental coverage when you compare them. If a health plan includes dental, the premium covers both health and dental coverage.

  • In some cases, separate dental plans are offered. You can see them when you shop for plans in the Marketplace. If you pick a separate dental plan, youll pay a separate premium. This is in addition to the premium you pay for your Marketplace health plan.

How to preview dental plans

The Separation Between Medicine And Dentistry

To truly understand whether or not health insurance should cover dentistry, it is first important to understand why these two health-promoting fields operate independently of one another.

Two-hundred years ago, barber-surgeonsthe dentists of the daypracticed tooth removal and repair as a mechanical challenge, offering dentistry alongside services like haircuts, leeching, and cupping. While the linkage between teeth and health has been present throughout ancient history, it wasnt a part of the cultural conversation at the time. In 1840, when the first dental college was opened by self-trained dentists who understood there was much more to dentistry than just repair and extraction, there was an opening for the two fields to integrate,

However, antiquated ideas about dentistry as incidental persisted in medical schools of the time, and the request to integrate dentistry into medicine was denied because of cost. In the cycles of attempts to integrate the two systems over the subsequent years, the impact of this rebuff resulted in a culture of dentistry fiercely attached to professional autonomy and dominion over healing the mouth.

Despite the legitimization of dentistry as a profession and the contemporary acceptance of the links between oral and overall health, the two health-promoting systems remained separateincluding in the realm of insurance coverage.

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How Common Is Embedded Pediatric Dental Insurance

The American Dental Association conducted an analysis of embedded dental coverage in health insurance plans sold through the exchanges in 2015. They studied 40 states, although only three of them had their own exchanges. The study found that in 27 of the states, dental benefits were embedded in less than half of the available health plans and in three states, dental benefits werent embedded in any of the plans.

Of the plans that did include embedded dental coverage, the vast majority only included pediatric dental, not coverage for adults. Virtually everyone who wants adult dental insurance must purchase it as additional coverage.

An ADA analysis of health plans available via HealthCare.gov found that from 2014 through 2016, the number of plans with embedded pediatric dental benefits grew by nearly 50%, from 659 plans in 2014 to 986 plans in 2016.

And as of 2020, a Milliman analysis found wide variation in terms of the availability of embedded pediatric dental in the 38 states that used HealthCare.gov that year. Six of those states had no plans with embedded pediatric dental, 24 states had at least some plans that included embedded pediatric and/or adult dental benefits, and the other eight states had too much variation to fit into any one category. The Milliman analysis did note that Silver-level plans were the most likely to have embedded pediatric dental coverage.

But Why Is Dental Insurance Separate From Medical Insurance

Individual Discount Dental Plans Vs Individual Dental Insurance ...

There doesn’t seem to be any one reason, but the history of dentistry started separately from the medical profession, according to a 2014 piece by The Atlantic’s Olga Khazan.

“The partition between dentistry and the rest of medicine dates back to the dental professionâs roots as an offshoot of hairdressing. Until the 1800s, barbers served as rudimentary dentists, pulling painful teeth and lancing abscesses after they finished trimming whiskers. In earlier centuries, people would see barbers for occasional bloodletting âhence the red-and-white striped pole.”

The division between medical doctors and dentists has continued into modern times, according to Joseph Errante, DDS, senior associate dean for clinical affairs at Columbia University’s College of Dental Medicine.

“The profession in general has always felt that they wanted to be separate and there’s probably a whole lot of philosophical reasons,” he said.

He said the division led to separate insurance products for medical problems and dental problems. Dental insurance is more of a benefit than actual insurance, according to Errante.

“Dental insurance is more of a financial product than a health product,” he said. “You give me some money, and I give you a benefit that caps out every year. It’s not really designed to pay for a catastrophic event.”

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Can I Buy Dental Insurance Without Health Insurance

Yes, you can buy dental insurance without health insurance. When you purchase a health insurance plan, it doesnt automatically include dental coverage. Dental insurance is separate from health insurance.

Unlike health insurance, you can buy dental insurance anytime of the year and from any insurance provider. You do not have to buy health insurance and dental insurance from the same insurance company. Make sure that the dental insurance plan you choose has the coverage and benefits that you and your family need.

Applying Tax Credits For Dental Insurance

Any leftover tax credit you don’t use to pay for your familys health insurance as purchased through Healthcare.gov may be applied to pediatric dental insurance premiums if your medical insurance policy does not include dental coverage. If your health insurance policy includes childrens dental coverage, you cannot use tax credits to buy an additional plan.

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Q: What Does Dental Insurance Cover

A: It depends on the plan. At the bare minimum, a dental insurance plan should cover routine checkups, cleanings, and X-rays. It might cover procedures like fillings, extractions, crowns, and bridges, too. Multiple kinds of oral surgery may be included as well.

Due to how varied dental coverage can be, don’t assume all plans are the same. Do your homework and make sure you understand what a particular policy will and won’t cover before you start paying for it.

Pediatric Dental Coverage Required Off

AARP® Dental Insurance Plan PPO Plan

If you shop off-exchange, pediatric dental is required. If you purchase an off-exchange plan, the carrier must be reasonably assured that you have exchange-certified pediatric dental coverage in place in order to sell you a policy without pediatric dental.

If you have no children under age 19 on your application and youre shopping off-exchange, you may be able to purchase a zero-premium adult pediatric dental plan. You wouldnt pay anything for the policy, but since it only covers children, it wouldnt provide any dental coverage for adults on the plan.

If you do have children under 19 on your application and youre shopping off-exchange, you are not allowed to opt out of pediatric dental coverage. You must either purchase pediatric dental coverage or attest to the fact that you already have it from another source.

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Tips For Buying Dental Insurance

As youre shopping for a dental insurance policy, make sure that your current dentist accepts the plan youre considering . Licensed insurance brokers like eHealth make it easy to search for plans that have your current dentist in network. You can start browsing dental insurance plans using eHealths plan finder tool or find individual and family plans that include dental coverage.

Before enrolling in any dental coverage, be sure to read the fine print to make sure you understand what youll be responsible for paying out of pocket, whats covered versus whats not, and what your deductible will be. You can save money by only buying what you need stand-alone policies these days are very customizable to suit your needs and budget. If you like, eHealths team of knowledgeable licensed insurance agents can walk you through your options. Just give us a call during business hours to get personalized help.

On a final note, dont put off shopping for a dental insurance plan. As mentioned, most plans have a waiting period of up to a few months before coverage will officially kick in, so the sooner you purchase a policy, the sooner you can start using your dental benefits.

Are Taxes Affected By Health Vision And Dental Insurance

You might be disappointed to learn that dental and vision insurance do not count as health insurance. This means if you only have this kind of product, you may have to pay the fee. This includes coverage only for vision care or dental care.

If dental or vision care is covered as part of your health insurance plan, you pay one monthly premium for everything.

If dental or vision care is not covered in the plan, you can purchase stand-alone policies to cover those services.

Are vision and dental tax-deductible?

You can deduct vision insurance premiums, eye exams, and eye surgeries from your taxes if you paid for those expenses out-of-pocket. But, any costs covered by a vision insurance plan are not tax-deductible. Additionally, you cant deduct any portion of your insurance premium that your employer paid.

Dental insurance premiums may be tax-deductible. The Internal Revenue Service says that to be deductible as a qualifying medical expense, the dental insurance must be for procedures to prevent or alleviate dental disease, including dental hygiene and preventive exams and treatments.

The full list of acceptable forms of tax-deductible health insurance can be found here.


You can purchase these stand-alone policies to cover specific services, but a complete health benefits package includes dental, vision, and life insurance coverage.

For more information on how to find the right plan for you, visit https://www.bdhealthinsurance.com/ or call us at 792-5100.

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My Teeth Are In My Body So Why Is Dental Separate From Health

It doesn’t make sense. We don’t have different insurance for our hands, our ears, our stomachs, our brains, etc. And if you’ve got mouth issues, it can profoundly affect your general health.

Take the tragic story of Deamonte Driver, a young boy in Maryland. He had a toothache that went unaddressed, and by the time he went to the hospital the bacteria from the abscess had spread to his brain. After two operations and more than six weeks of hospital care, Deamonte died. A routine tooth extraction would have saved him.

And poor oral health has serious economic implications. First, having more dental care requirements means paying more money. Second, there are studies that show for every tooth that’s missing you lose $720 in earnings.

Given how important dental health is to one’s holistic wellbeing, why on earth are health and dental separate? It all began with two dentists in Baltimore who were contemporaries of Edgar Allan Poe.

Does Medicaid Cover Dental Care

Individual Dental Insurance

Medicaid isn’t known for providing dental care coverage.

In fact, Medicaid is a lot like Medicare in that state agencies are only required to provide dental coverage to children. There are no minimum requirements for adult dental coverage.

States can choose whether or not they offer dental benefits to adults via their Medicaid programs. Unfortunately for those adults, many offer the bare minimum in this area.

What does that mean? Most Medicaid programs that cover dental care limit that coverage to emergency dental services. Some also cover preventative procedures, like cleanings and X-rays. Others expand their benefits a bit more to include the occasional filling or extraction.

That said, a handful of state Medicaid programs go the extra mile and cover enrollees’ crowns and root canals as well as their cleanings, fillings, and extractions.

Medicaid recipients often have a hard time getting a dentist to even examine them. Many U.S. dentists don’t accept Medicaid patients. Others accept them, but limit how many they’ll see.

Given that, the dental coverage some Medicaid programs provide adult enrollees isn’t always as great as it seems, even if that coverage usually is free.

If you have kids, though, Medicaid should help take care of their teeth no matter which state you call home. The same is true of the related Children’s Health Insurance Program .

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How Do I Get Dental Insurance

If you are an adult, there are plans that are offered through the ACA marketplace that include dental insurance. But its more likely that youll have to obtain dental insurance through an outside provider.

A offers a plethora of dental insurance options. But if youd like to speak to someone about what your options are, you can always speak with an insurance agent.

Dental insurance is not a requirement like your health insurance. But it is important to your overall health. Consider obtaining dental insurance to keep your overall health in tact.

Dental Plan Categories: High And Low

There are 2 categories of Marketplace dental plans: High and low.

  • High coverage level has higher premiums but lower copayments and deductibles. So you’ll pay more every month, but less when you get dental services.
  • Low coverage level has lower premiums but higher copayments and deductibles. So youll pay less every month, but more when you get dental services.

When you compare dental plans in the Marketplace, youll find details about each plans costs, copayments, deductibles, and services covered.

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The Reason Your Dental Work Isn’t Covered By Medical

    âThe reason dental is separate from medical is that the nature of the risk is fundamentally different as is the deferability of the care,â says Dr. Adam C. Powell, president of Payer+Provider …

How Do You Apply For Dental Insurance

Do You Need Dental Insurance?

There are a couple of ways you can get dental insurance:

  • Your employer may offer you dental coverage as part of your employment benefits. If so, you can apply for that during annual open enrollment. There may be different types of dental plans you can choose from that can help cover the type of dental care you expect to need.
  • If your employer doesnt offer dental insurance, or if you lose a job or work for yourself, you can buy a dental plan on your own. You can do this either through a state health exchange or directly from a health insurance company like Cigna.

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Its Much More Straightforward And Specific Than Medical Insurance

Thomas J Catalano is a CFP and Registered Investment Adviser with the state of South Carolina, where he launched his own financial advisory firm in 2018. Thomas’ experience gives him expertise in a variety of areas including investments, retirement, insurance, and financial planning.

Dental insurance policies help many people effectively budget for the cost of maintaining a great smile. Compared to medical insurance, understanding dental insurance policies is a breeze. Most policies are straightforward and specific regarding which procedures are covered and exactly how much you have to pay out of pocket. Dental insurance is available as part of medical insurance plans or as a stand-alone policy.

Dedicated Dental Insurance Plans

If you don’t get dental coverage through your health insurance, your only option is to get it directly from an insurer.

The good news here: all sorts of insurance companies sell individual dental plans these days.

Even better, most of these companies sell a range of dental plans. So, if you want “full coverage” that’ll help you and your family pay for the treatment of any dental or oral problems you may encounter, you can get that. And if you just want the basics covered, like routine checkups, cleanings, X-rays, and the occasional filling, you can get that, too.

Now for the bad news: you’ll pay quite a bit more for a “full coverage” dental insurance plan than you will for one that only covers the basics. How much more? Well, your “typical” dental insurance plan can cost about $350 a year. Full-coverage plans often cost more than twice that amount, or around $780.

Also, most private or individual dental plans include annual benefit limits of between $1,000 and $1,500. That means once you reach that amount, you have to pay for the rest of your dental care until the next policy year begins. All of it. Out of your own pocket.

Combine all of the above with the fact that private dental coverage rarely pays for cosmetic or even orthodontic procedures and it should be clear that you should approach buying this type of insurance with caution.

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