What is Dental Insurance – Do I Need It?

More than 50 per cent of Australians don’t have dental insurance.  This means a lot of people are choosing to skip or postpone treatment due to cost.  Even people with dental insurance delay or avoid the dentist because of out-of-pocket fees.

Oral health has been closely linked with overall health and is a predictor of many types of disease.  Without regular dental care, conditions can develop and go unnoticed leading to serious complications and illness.

What is Dental Insurance

Dental insurance is a contract between yourself as the patient and the dental insurance plan you choose.  Dental insurance pays for covered services and treatments, up to a certain limit.  Depending on your plan you will pay for some or all of the treatments.

Dental insurance plans usually cover three areas of care.  

• Preventive services – exams, cleanings, x-rays and fluoride treatments are usually paid for 100% by the plan.
• Basic services – fillings, non-surgical extractions and root canals are often paid between 80%- 100% by the plan
• Restorative services – crowns, implants, bridges, and dentures are usually covered between 50% - 80% by the plan.

These are average payments, and you have to carefully check the details of your plan to see exactly what’s covered.

Many dental plans will not cover teeth whitening, cosmetic dentistry or orthodontics.  Dental insurance plans consider these services to be non-essential to good oral health.  If you find a plan that does cover them, it may be at a smaller percentage, leaving you to pay the balance.

Types of Plans

Preferred Provider Organizations (PPO) plans provide dental care for a fixed monthly premium.  These plans allow you to visit any dentist within the PPO network for reduced service fees.  If you go outside of the network, some of your costs may still be covered, but your out-of-pocket costs will increase.

If you need a dentist in Parramatta that accepts insurance, there are many to choose from.

Dental Maintenance Organizations (DMOs) allow you to see any dentist within the approved network for no fees or for reduced cost.  DMO organisations do not pay anything if you see a Dr. outside the network. These plans work well if your Dr. is within the DMO network.   Sometimes DMO plans are less costly than a PPO plan.  

Pros and Cons of Dental Insurance

Insurance usually covers preventive care in full.  Regular care can safeguard your oral health and help dentists identify and treat problems proactively instead of reactively.  This leads to less costly care in the long run.

You can offset premiums with the money saved when you need dental care.  Root canals, extractions and other dental procedures can be expensive.  If regular preventive care can help you avoid some of these issues, it is worthwhile.

Insurance plans have coverage exclusions and stipulations.  If your plan doesn’t cover needed care, you end up paying for it out-of-pocket. 

Plans can limit your ability to go to the dentist of your choice.  If your preferred dentist does not accept your insurance, you have to pay for services yourself or find another dentist.