Dental Insurance not really insurance

Good article in Vox explaining how dental insurance works – and doesn’t. Also interesting that there’s no limit on the skim rate to the insurer in the dental world.

Obamacare limits “the skim” to 20% of premiums paid, Medicare Advantage, 15% (though there are ways around that limit an insurer can use to blow past 15% or 20% by sending a patient to an over priced captive, related company for treatment. The excess profit earned through the price gouging by the related company doesn’t count towards the Federal limits on “skim”.)



I have dental coverage through AARP United Healthcare Medicare Advantage HMO. $1000/yr coverage at no extra cost.

For check-ups, cleaning and occasional fillings it works fine. Most United Health Care is very into preventive care.

Yes, a crown or a root canal will probably cost more than that $1000 limit. But for the money its an excellent program.

You can ask if you decide to have your teeth capped or get implants are you covered. People with those needs might want better coverage. I’ll bet its available. But for one time care, I suspect expensive.

I thought the article missed the mark on my needs. Mostly it advised caution if you anticipate big dental expenses.

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Sure. It’s kind of like if health insurance paid for an EKG to diagnose a heart problem, but then you were on your own to fund the heart surgery.

The big point is that the more money that gets siphoned-off to overhead & profit, the less money there is for actual medical or dental care.

Also, the authors made the point that you need an awful lot of information and understanding about the cost and likelihood of various dental procedures to successfully game out your dental financing plan. You shouldn’t need an engineering degree and an MBA to successfully navigate health insurance in America.

I went to the dentist last month at the OHSU Dental School. They had one of the Professors of Pathology look at something on the roof of my mouth (academic exercise, no charge to me) and she suggested it might be a good idea to get that biopsied, “but don’t do it here. If you go to an Ear, Nose and Throat doctor to do the biopsy, it’s covered under Medicare.”

I appreciated the tip. Called my doctor on Wednesday, got a referral to an ENT surgeon on Friday morning, called the surgeon’s office on Friday afternoon, and got an appointment for Monday afternoon. Of course, I’m on traditional Medicare, so there was no insurance company involved slowing down the process. Biopsy was benign, so no problem.

Funny thing about that whole deal was that for years people on FoxNews have been telling me that you have to wait forever to see a doctor if you’re on Medicare, or any other Gov’t program. Maybe that’s true for Medicare Advantage, but it looks like smooth sailing under regular Medicare. Yeah, I had wait, over a weekend, from Friday to Monday, and the procedure being done was in no way an emergency. {{ LOL }}



Pay out of pocket for regular cleaning (floss and brush well twice daily and you can keep that down to once every year or two), normal fillings, at a low cost clinic.

If you have a bigger problem, go to Mexico and get it done with high quality at a deep discount.

Whenever you can sensibly rationally escape the USA “sheer the sheap” plantation system of not health care, do so.

david fb
(my HIV care in Mexico is superb and free, and my dentistry is excellent at about 30% of USA costs)



I’ve been going to the OHSU Dental School in Portland for about 15 years. Of course, things take longer to do since a Professor has to check the student’s work at several points in the process, but the quality of the work is high and half the cost of seeing a private dentist in town.

I’m also learning a little dentistry while I’m sitting in the chair. That may be useful in the future as we approach societal collapse, and we’ll be left to our own devices for dental care. {{ LOL }}



Our of interest, how does it work in a practical sense? As compared to trad Medicare and regular group health medical plans, MA is largely a capitation method of reimbursement…i.e. a flat fee paid to the physician for care vs. fee for service, where individual doctor-patient encounters are billed per visit/procedure.

Many doctors apparently do not like MA, either:

3 Reasons Doctors Do Not Like Medicare Advantage Plans.

I suppose MA works for some people. For example, I have some friends who moved to Mexico for quality of life/cost reasons and they seem to like MA there, although I don’t know why MA works well there and not so well in the US. Maybe it’s the type of benefits they use? Regular Medicare may not be available and that is the only reason they “like” it?

intercst may know the mechanics of that, too, since I’m curious and not at all an expert on MA.


From the perspective of comparison with dentistry (general dentistry, that is…what most folk mean when they talk about “going to the dentist”) you’re looking at primary care really. With a capitation method of reimbursement…regardless of third party payer…the provider ultimately gets an annual lump sum per patient and contracts to provide care for that fixed sum. I’m sure there are add ons for specific services, but that’s the basic principle. That works fine for the practice if the patients are healthy and well and make no to minimal demands. Almost money for doing nothing. Problem breaks down when a doctor’s…or dentist’s…office is used for what you’d expect. It’s very easy to run up expenses that start to outstrip that fixed capitation fee. Especially with dentistry that, in addition to cognitive skills, is largely procedure oriented and requires equipment and supplies that cost the same regardless of the patient’s third party payer.

That’s the real dilemma at primary care level. With traditional Medicare…and probably employer provided group health plans too…there are shrinking reimbursement levels that I don’t see changing, so less subsidy from that quarter.

I suspect it’s as you say with your friends, they personally “like” their plan because they haven’t seen a recognisable impact on what they experience. That’s why most folk say they “like” their plan. It suits them…for now. Doesn’t matter about anyone else.

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It seems that generally heath insurance (and dental insurance) depend very much on correctly anticipating your future needs. If you guess right you can sign up for the best treatments or the lowest cost.

Of course most of us have to rely on the luck of the draw. Then broad coverage for the unanticipated is needed.

Still the risk of medical expenses is far greater than dental. Dental bills over $10k are rare. Whereas that can be pocket change for a stay in the hospital.

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Medicare for the most part doesn’t work outside of the United States.

My Medigap plan has a lifetime $50,000 benefit for care received outside of the US. That’s fine if you get sick while on vacation in Mexico, but if you lived there permanently, you’d want other health insurance.

Maybe your friend sees Medicare Advantage as “emergency care”, in case he has to return to the US for something big like heart surgery?


The first dentist I saw when I moved to the Portland area had a young Ukrainian dental assistant who must have been a licensed dentist in the old country. She did all the work for a crown, except for the dentist did the actual drilling on the tooth the flatten it down to a stub. My only complaint was that they apparently don’t use lidocaine in the old country. She did the “cord packing” where they jam that piece of string between the gum and your tooth when they make the impression for the crown without any anesthetic. Ouch!

I’m sure it helps the profitability of a dental practice if most of the work is done by lower paid help.


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But of course. There are areas right across the board where it’s possible to cut corners and reduce costs…a good many that are much less obvious than the “barber-surgeon” level of care you’re documenting (you can see why patients fall for the idea that dentistry’s in the dark ages per the implications in the article upstream when there’s so much of the craptaculous going on) Infection control would be one area, cheapest available materials/lab manufacture etc…all things that a bargain hunter might not be concerned about