Supplementary dental insurance is purchased to fill gaps in the policyholder’s dental or medical coverage. Gaps in coverage can occur when public health insurance benefits are insufficient or when an insurance policy does not provide coverage for necessary or desired dental treatments.
And because many health insurance plans provide only inadequate dental coverage, dental insurance itself is often purchased as “supplemental insurance.
This article describes the most typical cases where supplemental dental insurance is needed, such as when there is limited or no dental insurance coverage, or when dental benefits run out because expensive treatments such as braces, root canals, crowns, and dental implants are needed.
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Comparison of supplementary dental insurance: do not jump the gun!
It is an unfortunate fact that dental insurance – in fact, any type of insurance – is often not easy to understand or use. Dental insurance is also often purchased without first doing a dental insurance comparison. The infamous “fine print,” exclusions, inclusions, requirements and exclusions can take you by surprise when you are already having a difficult time.
In general, supplemental dental insurance is easier to understand and use than private health insurance. Similar to health insurance for the self-employed, supplemental dental plans have no co-pays, no deductibles, no paperwork and no annual maximums. You simply go to a dentist who is part of your plan’s network – that is, a dentist who has agreed to offer discounted dental services to plan members – and pay the discounted rate directly to the dentist. No fuss, no worries and no confusion.
The best thing you can do is ask lots of questions before purchasing dental insurance, and don’t hesitate to get your dentist’s opinion on which insurance plan meets your dental needs. If you can’t decide which insurance plan to purchase, you can fill gaps in your coverage with supplemental dental insurance.
Supplementary dental insurance for people with statutory health insurance
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Statutory health insurance plans only provide limited coverage for dental treatments such as tooth extractions, dentures, bridges, root canals or crowns. There are some very limited exceptions to this rule – for example, if you need to be hospitalized for complicated or emergency dental treatment, hospital insurance may cover the inpatient costs, but not the fees for the actual dental treatments.
Therefore, SHI-insured individuals typically seek more comprehensive health care.
Some public health insurance plans cover special dental benefits, while others do not (see also Dental Insurance Benefits). Check your health insurance plan’s records to determine which dental benefits are included. Then check to see how many providers are in the plan’s network and if your dentist accepts the plan. Also check to see if the policy offers additional benefits that are important to you. Some policies offer vision and prescription drug benefits in addition to dental benefits.
Other options for those with SHI insurance include purchasing a stand-alone dental insurance policy from a private insurance company or a special supplemental dental insurance policy.
Insurance can be a good choice for basic preventive care, as it often includes free annual checkups, cleanings and x-rays for policyholders. Do you need more extensive dental care?
Supplemental dental insurance for those with private insurance
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Dental treatments are expensive. But with the average cost of a single root canal on a front tooth ranging from 600 to 1,200 euros (depending on where you live and what a particular dentist charges) and another 500 to 1,000 euros for a crown, which is often necessary after a root canal, it’s all too easy to exhaust your dental budget in one or two visits. Another budget eater is braces, which can cost anywhere from 3,000 to 7,000 euros or more over the course of treatment.
Supplemental insurance seems to be the solution if you’ve exceeded the annual limit on your dental insurance or if your insurance doesn’t cover a needed procedure. However, before you pay more for additional insurance, consider potential problems and your options.
A newly purchased dental insurance policy may not cover ongoing work or pre-existing conditions. Also, there is almost always a month-long waiting period before you are reimbursed for major procedures like crowns or root canals. Also, keep in mind that dental insurance often won’t cover restoration of teeth that were missing before the policy was purchased, or work that was started before the policy went into effect.
And it can be difficult to coordinate benefits from two dental insurance plans. If you make a mistake, your insurance claim may be denied, leaving you to pay for the cost of treatment. However, your dentist can schedule treatments to make the most of your insurance coverage.
If you want to find out how to pay for expensive dental treatments, it’s best to talk to your dentist and ask what they suggest. The dental office may offer payment plans that make it easier for you to afford the expensive treatment, or your dentist may know of a supplemental insurance plan that is perfect for your needs, or they may only need to defer part of the treatment until your insurance plan is renewed. Also, talk to your company’s human resources department if the plan is provided by your employer to see if they have any suggestions.
What should I look for when purchasing a supplemental dental policy?
Supplemental dental policies offer a particularly easy way to get dental care quickly and affordably without worrying about annual limits, pre-existing conditions or waiting periods.
Some people find that their needs are best met by purchasing both traditional dental insurance and a supplemental dental policy. Families with young children may want a policy that covers preventive care for the little ones and a savings plan that makes treatment more affordable for adults. Or they may want to purchase a supplemental dental policy to bridge the waiting periods for certain treatments mandated by insurance, or purchase a supplemental dental policy if their dentist tells them the treatment they need will cost more than the annual limit on their dental insurance.
In addition, some supplemental dental policies offer discounts for some dental specialties that are rarely covered by dental insurance, including cosmetic dental treatments such as veneers, teeth whitening and more. Those who need or want these treatments often sign up for a supplemental dental policy membership to receive a discounted rate for these services.
Coordinating dental insurance benefits
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Whether you purchase a supplemental dental insurance policy, a second dental insurance policy, or a supplemental dental policy, you should find out how (or if) your primary plan coordinates benefits. You can usually find this information in your plan’s policy documents. If you can’t find the information, contact your dentist or your insurer’s member services department.
Benefit coordination rules may vary. That’s why it’s important to check with your health care provider or insurance company about the details of your plan – and you may even want to check with both.
Coordination of benefits is essentially about deciding which insurance company is the “primary payer” – which insurance company pays first. To make matters even more complicated: The primary payer is not the one who pays first – it is the insurance company that is responsible for paying the bill up to the limits of your coverage. Anything above that goes to the second and maybe even a third payer.
If you and your spouse both have dental insurance that also covers your children, the insurance company of the spouse whose birthday is earlier in the year will be the primary payer. In other words: If you were born in January and your spouse’s birthday is in June, your insurance company is the primary payer. This may change in the event of a divorce or due to other legal issues, but it is the usual method for deciding whose insurance takes priority.
Even if your family is covered by two dental insurance plans, the second insurance plan is considered supplemental. You don’t get everything twice – for example, 4 free dental cleanings as opposed to 2. The second plan fills in the gaps left by the first plan. However, check the non-duplication provisions of both plans before assuming you are covered for services that the first plan covers.
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