21 Telemark Drive Ste. 107, Winter Park, Colorado

Misconceptions about Dental Insurance


If you find dental insurance plans confusing, you are not alone. There are many misconceptions about dental insurance and what it provides for you and your family. At Winter Park Dental, we do our best to make sure that you understand your dental insurance plan and we work hard to ensure you receive the most benefit possible. Despite all of this, there are common misunderstandings about dental insurance. Below are some of the common misconceptions (and truths) about dental insurance:

Misconception 1: Dental insurance is actually insurance.

The truth is dental insurance is not insurance but a benefit. Insurance is the equitable transfer of the risk of a loss, from one entity to another in exchange for payment. It is a form of risk management primarily used to hedge against the risk of contingent uncertain loss.

Most dental insurance plans do not eliminate your loss like most other types of insurance; they only mitigate your loss. Therefore, when you have dental insurance, it is very important to understand that it is more of a benefit plan than an insurance plan. It offers discounts on some things, but it is not insurance. Most insurance plans cover preventative services such as cleanings, x-rays, and exams, but for almost everything else it is only a discount. Once your yearly maximum is met this discount goes away even if you require additional treatment, and you pay 100% out of pocket. One of the major benefits of Winter Park Dental’s Care Plan is that there is no yearly maximum and often times it provides better coverage than dental insurance plans.

Misconception 2: Dental insurance will cover any treatment that you need.

Most dental insurance companies will not cover treatment on any condition that existed when you bought the plan. In addition to not covering pre-existing conditions, often insurance companies will require you to pay your premium for six months to a year before any major work can be done. Also, unless your dental insurance considers it a “dental necessity,” the odds of your plan covering it are very slim. For example, if a child is over 14 years old insurance companies will not cover sealants or fluoride treatment even though these are great preventative treatments that will benefit the child into adulthood.  Additionally, things like tooth whitening, tooth bonding, and veneers are often not covered. What’s worse, most dental insurance plans do not cover implants.  This often forces people to have a bridge done instead of an implant to replace a missing tooth. While both are good restorations, often an implant is a better, longer lasting solution for patients. This is an unfortunate situation where the insurance company is dictating the treatment, and the patient and dentist are restricted with what they can do.

Misconception 3: Dental insurance has kept up with the price of inflation.

Most of our patient’s with dental insurance at Winter Park Dental have a maximum annual limit around $1000-$1500. In recent years, inflation has been increasing at about 3-5% each year. If dental insurance kept up with inflation, maximum annual limits would be around $5000. The costs of materials, such as precious metals, and the cost of labor from the laboratories have increased in recent years, yet the annual maximum has stayed the same. Once your maximum is reached, you end up paying 100% out of pocket for all other treatment you require, and you are still paying the insurance premiums.

Misconception 4: I must have dental insurance to see a dentist.

Many people feel that they cannot see a dentist unless they have dental insurance. This is not true, but insurance companies have worked to make you believe this. Insurance companies have tried to dictate the care that our patients can receive. Patients are forced to choose what is best vs. what the insurance plan will cover. And dentists are forced to do treatment that may not be their top recommendation.

Misconception 5: You have a see a dentist that is in-network to receive your benefit.

Dental insurance companies want you to believe that you must see a “preferred provider” or an “in-network provider” in order to use your insurance plan. This is not true. At Winter Park Dental, we will accept and file to all insurance companies, even though we are not a preferred provider.  We believe that our fees should be the same for everyone, whether they have dental insurance or not. More importantly, we strive to provide the best quality work possible by using the best materials and laboratories available.

Dental insurance can greatly benefit some people, but it is not always the best option for everyone. That is why we are offering our Winter Park Dental Care Plan as a benefit option for patients of our practice. It allows you to get the preventative treatment you need yearly, as well as whatever care you need or want at a discounted rate. The best part is, when you pay the yearly premium you can get services the same day, there are no pre-determinations, no deductibles, no yearly maximums, and no pre-existing condition limitations. We are here to answer any questions you may have, give us a call at 970-726-5556!

Get a healthy smile here in Winter Park!

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