Wednesday, June 22, 2022

Why Is Dental Insurance Separate From Medical

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How To Change A Dental Plan

Why Dental Plans are Separate from Medical
  • You must be eligible for Medi-Cal to join a dental plan.
  • If you are not happy with your dental plan, you can choose another dental plan or return to Regular Medi-Cal if you live in Los Angeles County. If you live in Sacramento County, you may be required to be enrolled in a dental plan but you may change dental plans at any time.
  • To change your dental plan, call Health Care Options at 1-800-430-4263 Or you can complete a Medi-Cal Dental Choice form. You can find the form on the page.
  • Call Denti-Cal at 1-800-322-6384to find a dentist who takes Medi-Cal.
  • Mail the completed choice form.
  • Health Care Options will send you a letter telling you that the dental plan change has taken place.
  • You must see your present dentist until you get the letter from Health Care Options.

The Role Of Education

As the importance of oral health is increasingly recognized and practice patterns evolve to integrate oral health care into general health care, future generations of physicians and dentists can assume innovative oral health leadership roles. Medical and dental education will need to address the distinct needs of these future clinicians.

Interprofessional educationbeyond providing future professionals with specific clinical skillspresents promising opportunities to re-envision oral and general health care. The importance of preparing for team-based practice is reflected in accreditation requirements for nursing, medical, and dental education, all of which mandate inclusion of interprofessional experiences during training . Students can directly observe the value of their colleagues skill sets and contributions to patient care, and peer teaching can improve both learners and teachers confidence and knowledge . Future dentists and physicians trained in the importance of integrating oral health into our conceptions of overall health can be powerful advocates for eliminating barriers to such integration some of the most important barriers to address include a lack of interoperable electronic health records, differing reimbursement structures, and persistent health disparities. Interprofessional education models lead to knowledge sharing, improved understanding and communication and, most importantly, better patient care .

Medical Doctors & Insurance Providers See Dental Care As Non

Today, many medical professionals and insurance providers still view dental care as non-essential. That means, they do not view dental health concerns as life threatening, and for this reason, believe they should not be covered by medical insurance. However, research continues to show links between dental health issues and chronic and systemic illnesses.

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Overview Of The System

First, heres a breakdown of how private dental insurance works. You select a plan based on the providers you want to be able to choose from and what you can afford to pay.

  • If you already have a dentist you like, and they are in the insurance companys network, youll be able to opt for one of the less expensive plans.
  • If you dont have a dentist at all, you can choose from the dentists who are in the network and again have the option of a less expensive plan.
  • If your existing dentist is not in the network, you can still get insurance, but youll pay significantly more to see your dentist than an in-network oneso much more that you may not have any chance at coming out ahead by being insured.

The monthly premiums will depend on the insurance company, your location, and the plan you choose. For many people the monthly premium will be around $50 a month. This means that youre spending $600 on dental costs each year even if you dont get any work done.

What Do Most Dental Insurance Plans Cover

The Reason Dental Insurance Is Separate From Medical

Dental plans include coverage for preventive care like routine exams, cleanings, and X-rays. Some plans require a copay for preventive services while others cover those services 100% with no copay. It depends on the plan you choose, but preventive services are usually covered. Many dental plans also include coverage for basic services like fillings and extractions, and major services like root canals, crowns and more.

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Why Is Dentistry Separate From Medicine

Oral diseases differ from diseases that occur in other areas of the body. They often have unique triggers and symptoms, which means they should be treated as such. Oral diseases can also be an indication of a more serious disease or give your medical provider a heads up that something is not right in another area of your body.

Because of this, your dental plan should be different than your traditional medical plan. This ensures that you have the coverage and protection you need to screen for or treat each disease as its own entity without lumping it into one broad category.

Adult & Child Dental Insurance In The Marketplace

Under the health care law, dental insurance is treated differently for adults and children 18 and under.

  • Dental coverage is an essential health benefit for children. This means if youre getting health coverage for someone 18 or younger, dental coverage must be available for your child either as part of a health plan or as a stand-alone plan. Note: While dental coverage for children must be available to you, you dont have to buy it.
  • Dental coverage isn’t an essential health benefit for adults. Insurers dont have to offer adult dental coverage.

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Limitations Of Dental Insurance Plans

Every plan has a cap on what it will pay during a plan year, and for many that cap is quite low. This is the annual maximum. You pay all expenses that go beyond that amount. About half of dental PPOs offer annual maximums of less than $1,500. If thatâs your plan, youâd be responsible for all expenses above $1,500. If you need a crown, a root canal, or oral surgery, you can reach the maximum quickly.

Thereâs generally a separate lifetime maximum for orthodontics costs.

Some plans may totally exclude certain services or treatment to lower costs. Know specifically what services the plan covers and excludes.

But there are certain limitations and exclusions in most dental insurance plans that are designed to keep dentistrys costs from going up without penalizing the patient. All plans exclude experimental procedures and services not performed by or under the supervision of a dentist, but there may be some less obvious exclusions. Sometimes, dental coverage and medical health insurance may overlap. Read and understand the conditions of your dental insurance plan. Exclusions in your dental plan may be covered by your medical insurance.

Does The Affordable Care Act Cover Dental

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No, the ACA, also known as Obamacare, does not cover dental coverage for adults. You will not face a tax penalty for not having dental insurance. However, the Affordable Care Act does mandate that dental insurance be made available to you if you have children, though you arent required to buy coverage for yourself as an adult.

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The Barbaric History Of Dentistry

Despite it being a plainly medical issue, oral health has always been an outlier. Until the 1800s, dentistry was the domain of barbershops, practiced in the same chair and usually by the same guy who shaved your beard.

How would you feel if you went to your hairdresser and they pulled your tooth or lanced your abscess? asks Dr. Glassman.

Its so bizarre and frightful an image that its almost comical, but the history of our teeth and jaws being treated as something as incidental as our hair and nails still haunts us.

Dentistry has always had a disconnect to medicine, says Dr. Michael Tischler who specializes in reconstructive dentistry and the implant editor for Dentistry Today. In 1840 dentistry was proposed as a medical specialty to the University of Maryland in Baltimore and rejected.

We may have since greatly evolved in how we regard and understand dentistry, but we havent embraced it as a primarily medical issue if we had, it would be covered under medical insurance, or at least, things like a root canal would be, because if you need a root canal and dont get one, you could end up with all kinds of lethal problems that lead to hospitalization. It is rumored that Queen Elizabeth died from blood poisoning as a result of an untreated tooth infection. That was a long time ago, but hey, it happens.

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 or call us at 792-5100.

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Overview Of Dental Insurance

First, heres a breakdown of how individual dental insurance works. You select a plan based on the providers who you want to be able to visit and what you can afford to pay.

  • If you already have a dentist you like and they are in the insurance companys network, youll be able to opt for one of the less expensive plans.
  • If you dont have a dentist at all, you can choose from any of the dentists who are in the network and again have the option of a less expensive plan.
  • If your existing dentist is not in the network, you can still get insurance, but youll pay significantly more to see an out-of-network providerso much more that you may not have any chance at coming out ahead by being insured.

The monthly premiums will depend on the insurance company, your location, and the plan that you choose. For many people, the monthly premium will be around $50 a month. This means that youre spending $600 on dental costs each year even if you dont get any work done.

Waiting Period For Dental Insurance

Oral health is crucial to overall health. So why is dental insurance ...

Most dental insurance policies have waiting periods ranging from six to 12 months before any standard work can be done. Waiting periods for major work are typically longer and can be up to two years. These periods are set in place by insurance companies to guarantee that they profit off a new account and to discourage people from applying for a new policy to cover impending procedures.

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A Cost Benefit Analysis Of Expanding Dental Insurance Coverage


Dental health insurance coverage in the United States is either nonexistent , spotty and limited . Perhaps as a result, dental health in the United States is not good. What public policy makers may not appreciate is that this may well be impacting medical care costs in a way that improved dental benefits would produce a substantial return to investment in expanded dental insurance coverage.

On the surface, it would appear to be politically and economically difficult or impossible to expand dental insurance coverage at this time. Health insurance costs have been rising at double digit rates. Most employers have been dropping health care coverage rather than expanding it . Medicare trust funds are bankrupt . Adding coverage would exacerbate an already alarming problem. Medicaid funding is a major source of state government deficits. Many states are slashing Medicaid coverage during this time of crisis . Improving Medicaid dental coverage during times of budget crisis would meet substantial political resistance.

Dental Insurance and Coverage in the United States

The Relationship Between Dental Problems and Chronic Illness

Implications for Health Policy

Most common chronic US illnesses. Anderson

Percentage of healthcare spending for individuals with chronic conditions by type of insurance 2006. Anderson

Per capita healthcare spending and number of chronic conditions 2006. Anderson

The Difference Between Health Vision And Dental Insurance

People often think of health, vision, and dental insurance as being one and the same. Although it might seem like a no-brainer, it can be hard to differentiate between this trio because theyre often spoken about as a comprehensive 3-in-1 health plan.

Its important to understand health, vision, and dental insurance as separate entities, though. Each of these could affect key aspects of life including emergency situations and even taxes.

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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.

Deductibles Copays And Coinsurance

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An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. For example, if the deductible is $200, and the covered individuals procedure is $179, the insurance does not kick in and the individual pays the entire amount. Copays, which are a set dollar amount, may also be required at the time of the procedure.

When a dental deductible is met, most policies only cover a percentage of the remaining costs. The remaining balance of the bill paid by the patient is called coinsurance, which typically ranges from 20% to 80% of the total bill.

Costs and what procedures are required may also differ based on the patient’s age. Seniors on Medicare, for instance, will have a different definition of what constitutes the best dental insurance possible than other age groups.

Most dental insurance plans follow the 100/80/50 payment structure: They pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.

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What Is Not Covered By Dental Insurance

This depends on the type of dental insurance plan you choose. For example, dental services like bridges, crowns, dentures, and root canals may not be covered if you only buy a preventive dental plan. Here are some kinds of dental treatments that may not be covered:

  • Anything cosmetic, such as teeth whitening and veneers.
  • Orthodontic appliances such as braces, removable teeth aligners, or retainers may not be included in all types of dental plans. If you are looking for dental insurance with orthodontic benefits, be sure you understand the details of any plan youre considering. For example, there could be differences in coverage for the orthodontists services vs. the coverage for the actual orthodontic appliances, like braces or retainers.

The key to making sure your dental plan covers certain types of treatment, is to plan ahead for the dental care you and your family expect to need.

Dental Coverage Is Available 2 Ways

  • Health plans that include dental coverage. Dental coverage is included in some Marketplace health plans. 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, stand-alone plans are offered. You can see them when you shop for plans in the Marketplace. If you choose a separate dental plan, youll pay a separate, additional premium.

How to preview dental plans

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How Do You Apply For 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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