Did you ever need to ask “what is a dental insurance maximum benefit” when you discovered that your dental insurance did not cover something and you are left with a large dental bill? Or, did you ever find that you needed quite a bit of dental work to get back in shape, but the insurance coverage was way short of what you needed? This is due to your yearly “Maximum Benefit”. There are a few plans existing which do not have annual maximums, but they are few and far between. Most plans will include an annual maximum of anywhere between $200.00 to $4000.00.
Each time your dental office submits to your insurance company for services, the dollar amount paid out will be calculated against your yearly maximum. Once the insurance has paid out that maximum, you will not have any more insurance to use until your plan renews for the following year. In general, this is a reasonable approach to insurance companies paying out on claims. However, it is interesting to note that dental insurance has not made much of an attempt to keep up with inflation.
Dental insurance came about in the 1970’s, and it was readily accepted and used. For some people, it was the first time dentistry seemed affordable. Since the exams and cleanings and xrays were generally covered at 100%, it was foolish not to have these services done every year. When/as/or if restorative work was needed (cavities found, etc.), there would be some cost to the patient, but the insurance company would help with a percentage of the cost. Here is the interesting part: the annual maximums were set around $1500.00 per year. Back in the 1970’s, $1500.00 would cover quite a bit of dentistry; it could easily cover multiple crowns and fillings, with a few root canals thrown in as well. (Keep in mind that the cost of living was quite a bit less in those days. The price of regular gas was.36, a new car was $3853, the average annual income was $11859, and tuition at Harvard was $2800.)
So, given that perspective, it is easily seen that dental insurance will not really provide much beyond simple cleanings and check-ups, with a couple of simple fillings, and maybe one crown or root canal. If your needs go beyond that, it will be at your expense. With the dental insurance maximum, is it really worth the cost of premiums? This is a question that you must ask yourself. Every person’s dental needs are different. On the plus side, it can be viewed as a small bit of help to keep your mouth healthy. On the negative side, the cost of the premiums may out-weigh the benefits. In either case, dental insurance should not be dictating the type or amount of dental treatment you choose.
When you experience some disappointment regarding your dental insurance maximum benefit it will be important to remember that you and your dentist are partners in deciding your dental future. After all, what else can impact your life as much regarding your enjoyment of meals, your conversations, your smile and, don’t forget, your kiss!