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MONDAY, MAY 3, 2021 | Jessica L.

Supplementary dental insurance: What you need to know

Supplementary dental insurance: What you need to know

Why private supplementary dental insurance is worthwhile!

For most patients, going to the dentist becomes expensive from the mid-40s onwards, at which point almost everyone will need expensive dentures at some point. According to Stiftung Warentest, private households spend between $6 and $7 billion on dental services. Health insurance companies pay only a fraction of the treatment costs. If the patient has not made private provision and has dental insurance, he or she is left to bear a large part of the costs. That is why private supplementary dental insurance is one of the sensible private supplementary health insurance policies.

Who pays what: health insurance, supplementary dental insurance and co-payment.

How much do you have to pay for dental treatment? How much do you have to pay yourself? What does the health insurance cover? And what does supplementary dental insurance cover? In the following, you can read how the costs are divided between health insurance and private dental insurance and what your own share will be.

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Statutory health insurance only pays for standard care

The statutory health insurance only covers the costs for the so-called standard care. According to the US Social Security Code, standard care means dental treatment that is “sufficient, appropriate and economical”. For example, if you have a hole in your molar, the insurance company will pay for an amalgam filling. However, if you would like a higher-quality and longer-lasting plastic filling, you will have to bear the additional costs yourself.

Your own contribution for more complex dental treatments

For more complex dental prosthesis treatments, the division of costs between health insurance, supplementary insurance and co-payment becomes more complicated. Roughly speaking, the health insurance company pays half of the standard treatment for dental prostheses. You have to pay the rest yourself.

If, in consultation with your dentist, you decide to have a treatment that is not covered by the standard treatment, for example, a tooth-friendly and durable implant instead of a bridge, it will be really expensive. Then your co-payment is half of the standard treatment plus the material and treatment costs for the better treatment. This is where private supplementary dental insurance comes in. Depending on the tariff, it covers your share of the standard treatment or the total costs at a fixed percentage.

Cost absorption with a well-maintained bonus booklet

The prerequisite for maximum cost coverage by the health insurance company is a well-maintained bonus booklet. Only those who can provide complete proof of annual checkups by the dentist over a period of 10 years will receive the maximum subsidy of 65% from the health insurance company. Those who have been to the dentist for check-ups once a year for 5 years can expect a cost subsidy of 60%. Without proof of a visit to the dentist, the contribution from the health insurance company drops to 50%.

This percentage only applies to simple, expedient standard care. However, if you opt for a higher-quality dental prosthesis such as a better crown (table/line 2), the health insurance contribution remains at $181, since the standard care only provides for a simple crown (table/line 1).

It is a misconception that a well-maintained bonus booklet alone protects against high dental bills. Only together with the right supplementary dental insurance can the co-payment for major dental treatments actually be significantly reduced.

Does private supplementary dental insurance cover all costs?

Only in exceptional cases does the dental insurance actually cover 100% of the treatment costs. As a rule, with private supplementary dental insurance, you will have to pay a portion, albeit a much smaller one, out of your own pocket.

How does billing work with supplementary dental insurance?

If major treatments are necessary, the dentist will provide you with a so-called treatment and cost plan before starting. This is a kind of cost estimate that shows how expensive the treatment will be. You submit this schedule to your health insurance company and a copy to the supplementary dental insurance company. Some dental offices will handle the mailing as a service to you.

When the treatment is completed, you will receive an invoice from the dentist with the health insurance contribution already deducted. With a regular payment deadline of 30 days, you can submit the invoice to the supplementary insurance company and have a good chance of receiving the money from the supplementary dental insurance company before you transfer it to the dentist.

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The benefits of private supplementary dental insurance

The benefits catalog of private supplementary dental insurance varies greatly. Each insurance company naturally puts its benefits in the best light and wants to convince you of its merits. But how do you know which benefits are really important? What criteria are important and how high the percentage of costs covered by the dental insurance should be?

Here we present the most important benefit areas of private supplementary dental insurance. You can use these to orient yourself and compare different rates with each other.

  • Dental prosthesis: The cost coverage of the supplementary dental insurance in the area of dental prosthesis is particularly important, since the highest costs can arise here. Very good providers cover up to 95% for crowns, bridges, inlays and implants; at least 80% should be covered. Make sure there is no quantity limit for implants or inlays.
  • Dental treatment and tooth preservation: In the case of treatment for tooth preservation, e.g. fillings, root canal treatment or periodontal treatment, the benefits provided by the health insurance companies are better than in the area of dentures. Find out in advance from your insurance company which costs are covered. Good supplementary dental insurance will cover any extra costs incurred for root canal treatments and tooth-colored plastic fillings in the posterior region.
  • Dental cleaning: Prophylaxis should also be covered or subsidized by a good supplemental dental insurance plan. Providers differ in whether a certain amount is paid over a defined period of time; i.e., whether a percentage of the cost is covered per treatment or whether a predetermined number of treatments are covered.

What do low-cost supplementary dental insurance plans cover?

The range of rates for private dental insurance is very wide; you will find policies for under $10 monthly premium and those for over $50. But what is the difference between cheap and expensive supplementary dental insurance? Roughly speaking, in the percentage of reimbursement.

Inexpensive tariffs often only cover the costs of standard care. This means that they cover the remaining 35-50% that the insurance company does not cover. Comfort tariffs, which charge significantly higher premiums, provide coverage for dental treatments that go beyond the standard treatment, for dentures and also in areas of prophylaxis.

We advise against extremely low-cost basic tariffs. With such a policy, you would not receive the best possible treatment for your teeth despite additional insurance, as only standard care is covered. If you can invest $10 to $20 more per month in your health, you will get a fully-fledged supplementary dental insurance policy that offers you much better protection.

Contributions to supplementary dental insurance: Those who take out later pay more.

It is not only the different range of benefits offered by supplementary dental insurance that plays a major role in calculating premiums and covering costs. The age of the insured and his or her dental status when taking out the insurance also have an influence on the premiums and benefits of the supplementary dental insurance. The younger a policyholder is when taking out supplementary dental insurance, the lower the premiums. This is because more expensive dental treatments become necessary with age, and insurance companies shift this risk to the insured.

As a rule of thumb, it is best to take out private supplementary dental insurance before the age of 40 - premiums become expensive later.

Do you choose supplementary dental insurance with or without an age provision?

Supplementary dental insurance is available with or without an age provision. Policies with age provisions, which are calculated in the same way as life insurance, build up age provisions over the entire term. This means that these tariffs are somewhat more expensive in the early years of the contract, but you benefit from premium stability in old age. Disadvantage: If you cancel a supplementary dental insurance policy with age reserves, you lose the savings portion of the policy.

The situation is different for policies without age provision. Here, no buffer is built up for old age and the policy is calculated according to the type of claims insurance. This means that the insurance becomes more and more expensive over time, because the expected claim also becomes more likely in old age. Insureds may benefit from low premiums when they take out the policy, but they must expect to pay considerably more for their private supplementary dental insurance when they get older. This is a risk, because income falls, especially in old age. The insured can then no longer afford the premiums when they need the insurance cover most urgently.

Our tip: Only choose a rate without an age provision if you intend to cancel. If you want to commit to an insurer for the long term and take out supplementary dental insurance before the age of 40, we recommend a rate with an age provision. Supplementary dental insurance without an age provision is only worthwhile if you know when you take out the insurance that you will be cancelling it sooner or later.

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Dental insurance: Health check determines the amount of the insurance premium

Before taking out supplementary dental insurance, you must fill out a health questionnaire. The insurer wants to know from you whether treatment has been advised by the dentist, whether there are ongoing therapies, whether you suffer from acute complaints, whether any teeth are missing or whether you already have dentures. Based on your answers, the supplementary dental insurance calculates your personal risk for dentures and dental treatments and thus determines the amount of your insurance premium.

Dental insurance does not pay for treatments already started

In most cases, the costs for treatments that have already begun or are pending are excluded from the insurance from the outset. Treatment is considered to have begun as soon as a dentist has diagnosed the problem - even if a treatment and cost plan has not yet been drawn up. Even a note in your patient file is sufficient to exclude insurance coverage for this “planned” treatment. If you are unsure about your dental status or planned treatments, be sure to contact your dentist.

What to do if denied due to poor dental health?

If your teeth are in very poor condition or you are missing several teeth, you may not even be covered at all. In this case, try a different insurance company. Since the health assessment questions vary from provider to provider, you still have a chance of getting coverage.

Many supplementary dental insurances only pay after a waiting period has elapsed

Regardless of the health check, most dental insurance plans will not pay until after a 3-month waiting period. For dental prostheses, payment is usually only made after 8 months. There are often additional price scales in the first three to five contract years, which limit the benefits of the supplementary dental insurance. In many tariffs, the full scope of benefits is only paid after several years.

Caution: Always answer health questions truthfully

By the way, cheating on the health questions is not a good idea: If a claim occurs, the insurer will check your information carefully. In the event of fraud, the insurer can withdraw from the policy, cancel it and, in the worst case, demand repayment of money already paid.

When does it start making sense to take out supplementary dental insurance?

  • Up to the age of 25: Even if insurance companies entice young people with low premiums, dental insurance should not be taken out too early. With young, healthy teeth, a claim is not likely until later and you would be paying premiums for a very long time without being able to take advantage of the benefits of supplementary dental insurance to any great extent.
  • Between the ages of 26 and 40: Now is the best time to purchase supplemental dental insurance. The premiums are in good proportion with the expected benefits. The exact time to take out supplementary dental insurance depends on the individual health of your teeth. But don’t wait too long to take out the policy - once the claim has been made, you can no longer benefit from the protection of supplementary dental insurance.
  • After the 40th birthday: Even if the premiums become higher with increasing age, there are still many, very good private supplementary dental insurances. Especially if your teeth are still largely in order. Large differences between dental insurance companies now exist in the area of benefit exclusions. When comparing insurance, you should pay particular attention to this point.
  • For seniors: Since there are providers who waive a maximum age of admission, you could take out a supplementary dental insurance in principle even into old age. You should keep your hands off special tariffs for seniors. These tariffs are usually expensive and offer only limited benefits. It is better to take out a normal contract that offers good benefits in the areas of dentures, dental treatment and prophylaxis. You can usually do without benefits in the area of orthodontics. Also make sure that missing teeth or dentures are not an exclusion criterion and that existing dentures are also insured. You can do without a tariff with an age provision, as premiums do not increase with most insurers after the age of 61.
  • With predictability: In addition to your age, the predictability of dental treatments also plays a decisive role in choosing the appropriate time for dental insurance. Almost all older fillings, bridges, crowns or root canal-treated teeth will need to be replaced or retreated at some point. So ask yourself when it’s likely that you’ll need new dental treatment. If you don’t currently have any problems with the filling, it won’t negatively affect your premium calculations. It is important to purchase supplemental dental insurance in a timely manner while the treated tooth is still considered healthy, i.e., before the dentist makes a new diagnosis.

When it is not worth taking out dental insurance

Private supplementary dental insurance is not cheap. Monthly premium costs of up to $50 are common. If you can foresee that you will not be able to afford private supplementary insurance in the long term, you should refrain from taking out supplementary dental insurance and prefer to save the premiums privately, for example in a call money account. Low-income earners have the option of applying for an extra subsidy from their statutory health insurance fund if dental costs are high. For a single person earning less than $1,162 per month, for example, the fixed subsidy from the health insurance company would then double.

Comparing supplementary dental insurance: How do I find the best rate?

Online comparison portals and independent test institutes such as Stiftung Warentest regularly compile rankings of the best supplementary dental insurances in the US. These results provide a very good orientation. However, you should not simply adopt the test winners, but analyze them critically for your personal insurance needs. The comparisons are based on an average model customer, who may have little in common with you.

Checklist for comparing private supplementary dental insurances

Based on the following questions, you can check your desired tariff and decide whether it meets your insurance needs.

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