The insurance landscape is complex and difficult for most to understand — regardless of how long they’ve been in charge of their own plan. Every plan from every carrier is different in some way, and many don’t know whether a treatment will be covered until it's needed.
Both medical insurance and dental insurance plans help reduce the cost of different types of health care, but there is much more to it than that. We’re here to help you get a better grasp on what is covered by each type of insurance so you can make sure you’ve got the coverage you need to keep yourself and your family healthy.
Is dental insurance the same as medical insurance?
In short: no. Medical insurance certainly covers a variety of health care needs, it does not include dental care. See how dental and medical insurance are similar and how they differ below.
Similarities between medical and dental insurance
Both medical and dental insurance plans require you to pay a monthly premium for a certain amount of coverage, which will differ based on your plan. Because of this coverage, your benefits will eliminate or at least reduce out-of-pocket costs for everything from routine exams all the way up to major treatments and procedures. Additionally, for both dental and medical insurance, certain providers are considered in-network, and by sticking with those providers you’ll further lower your costs.
There may also be circumstances where the two overlap — for example, having dental clearance prior to surgery to rule out dental abscesses or gum disease.
Differences between medical and dental insurance
While the overall concept of medical and dental insurance is generally the same, there are specific differences in what they cover. Medical insurance covers care related to your overall health and well-being. This includes routine physicals, as well as treatments for injuries, chronic illness, and even specialized services pertaining to women’s health, dermatology, allergy, orthopedics, and so on.
Dental insurance on the other hand is very focused on tooth and gum health. Basic dental coverage typically eradicates costs for cleanings and checkups, X-rays and other mild procedures, while full coverage will carry the brunt of costs for more extensive treatments like crowns, bridges, and extractions.
Does health insurance cover dental work?
Typically, health insurance does not cover oral care. Preventive care and most dental and orthodontic work falls under dental insurance.
In rare cases, dental work may be medically necessary and therefore fall under medical insurance. For instance, an abscessed tooth may be leading to other health issues and require surgery.
Does Medicare cover dental work?
Like traditional medical insurance, Medicare, for the most part, does not cover preventive or routine dental care like cleanings, fillings, extractions, or dental devices — nor are there Medicare dental plans available for purchase.
However, Medicare Part A, which is hospital insurance, will pay for certain dental services a patient may need while staying in the hospital. These are typically emergency or more complicated procedures that cannot be performed in a dentist’s office.
Why is dental insurance separate from medical insurance?
The goal for medical insurance is to reduce costs for those who need treatment for illness and injury — making it more of a reactive safety net. It provides a peace of mind for individuals to know if and when the time comes they need treatment or a procedure, they won’t owe thousands of dollars.
Dental insurance, on the other hand, is more proactive, aimed at keeping patients’ mouths healthy and preventing more serious conditions. With regular exams, a dentist can catch problems before they worsen or cause other health issues.
Get comprehensive dental coverage from Direct Benefits
Even if you already have private or employer-provided health insurance, you’ll need to enroll in dental insurance separately. Don’t be concerned about costs — you can find affordable coverage that meets your needs and will in fact save you money on care.
Search the Direct Benefits marketplace to compare plans and enroll today.