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The Difference Between Dental and Medical Insurance

A person's hands are shown typing on a laptop with the screen showing a dentist and the word dental

For many people, insurance is something they know they have to have, but they may not know anything about. The right insurance can help you pay for procedures and reduce or even eliminate the cost burden of care in certain situations. But trying to decide the right insurance for you–especially when it comes to differentiating between health and dental insurance–can leave you with more questions than answers.

The team at Norman Smile Center can help. Drs. Kristen Campbell and Donna Sparks of Norman Smile Center have dedicated their careers to providing high quality, affordable dental care, serving pediatric, teen, and adult patients in and around the Norman, Oklahoma, area for more than 30 years. In addition to compassionate, comprehensive care, Norman Smile Center offers the latest in precision dentistry, digital imaging, and diagnostics for dental health services that are second-to-none, while a friendly and experienced staff helps patients navigate the nuances of dental insurance, plan coverage, and membership options.


A Brief History of Dental and Medical Insurance

Dental and medical insurance share the same principle–to help you afford the care you need–but due to the history of health insurance and dentistry in the U.S., they are two distinct entities. 

Dental schooling has been available in the US since the 1840s, but it was always treated as a separate discipline from the rest of the medical field, establishing the belief that “dental” and “medical” are two different, unrelated things. Moreover, health insurance arose in the late 1800s, while the concept of dental insurance wasn’t adopted until the 1950s, further cementing an environment where dental care operates outside of the medical realm. 

Also, unlike health insurance companies that are primarily focused on the biggest threats to people’s health–particularly heart disease, cancer, and infectious disease, the top three killers in the US–the dental field rarely deals with life-threatening issues, so dental work is considered supplementary to “primary” medical insurance and is not considered an “essential health benefit.” 


How Medical Insurance Works

Medical insurance is considered essential because it must cover 10 basic benefits that address common health needs. They are:

  • Outpatient care
  • Emergency care
  • Hospital stays
  • Mental health
  • Prescription drugs
  • Rehabilitation
  • Lab work
  • Preventive care
  • Maternity care
  • Pediatric care

This type of insurance protection includes some preventive work, such as the mandate for free checkups or certain low-cost vaccinations, but it primarily focuses on unexpected, reactive treatment. For example, if you have a heart attack, you will need emergency treatment in a hospital, where you may need to stay for some time. No one expects to have a heart attack, and so medical insurance is intended to cover these surprising (and often costly) medical expenses.

How Dental Insurance Works

In contrast, dental insurance is more proactive in nature than reactive, focusing much less on life-threatening illnesses and almost exclusively on a smaller range of preventative services and targeted care. Very few instances regarding dental health are an unpredictable emergency. Even when they are, medical insurance may still cover the dental services, such as when a person suffers a traumatic injury to the face or is undergoing treatment for a severe infection that impacts their dentition.

To understand your dental insurance better, it helps to think of it more as a voucher or prepaid gift card as opposed to traditional home, vehicle, or medical insurance. While these plans function by covering 100% of costs after you’ve met your deductible, dental insurance is the opposite. You pay a premium to receive a certain amount of annual benefits; once those benefits are used up, there are no more for the year, and you are now responsible for 100% of any additional costs or services related to your dental health.

Here are some other important aspects of dental insurance:

Covered Services

The covered services listed in your dental insurance are the types of treatments that your insurance will pay for, either in part or in full. While each insurance plan is different, most will include the following treatments as part of their covered services:

  • Cleanings
  • Exams
  • Fluoride treatments
  • X-rays
  • Fillings
  • Root canals
  • Crowns
  • Bridges

Preventive care is typically low or no cost, but other procedures or services considered non-essential–like teeth whitening–may only be covered a certain percentage, if at all.


The deductible is the dollar amount that indicates how much you must pay out of pocket before your insurance starts to help. If you have a deductible of $250 and you receive a $500 filling, you will pay $250, and then insurance will pay at its specified rate for the remaining $250. Your deductible resets each year. The lower the deductible, the higher the cost of the insurance policy premium, on average.

Copay and Coinsurance

A copay is a fixed amount due for a specific type of service. For instance, a dental visit may have a copay of $30. This $30 can count toward your deductible, but you must pay it each time you visit. Coinsurance is the amount you pay after you have met your deductible. For example, if your dental insurance offers 20% coinsurance, this means that your plan will pay for 80% of the cost of a procedure, and you’ll pay 20%, as long as you’ve met your deductible first.

Annual Benefit

The annual benefit is what sets dental insurance apart from medical. Your maximum annual benefit is the maximum amount your dental insurance will pay for in a given year. Once this amount is reached, the patient is responsible for paying 100% of any additional services or costs. Here’s more on how to get the most of your annual and end-of-year dental benefits. 

Waiting Period

Most dental insurance plans implement a waiting period for large procedures. This way, they protect themselves against patients who enroll in a very good dental plan just to get an expensive treatment, then change to a cheaper plan. You may need to wait multiple months after you enroll depending on the type of treatment.

Dental Plan Types

Dental insurance is available through multiple sources. Most people get it from their employers, but private insurers also offer plans. Alternatively, the healthcare marketplace provides options for dental insurance, but going this route requires simultaneously purchasing a medical plan.

While most dental plans contain the same insurance terms, the plans themselves come in multiple types as well. Patients must decide among:

PPOs, or “preferred provider organizations,” which tend to be a slightly more expensive option because they utilize a network of pre-selected dental professionals. The advantage of this method is that patients can go to any in-network provider (and most out-of-network providers) they want to without a referral. This flexibility comes in exchange for a higher price point.

HMOs, or “health maintenance organizations,” which come at a lower cost, but with more restrictions on who you can visit, and you typically need to wait for referrals. HMOs may not cover out-of-network service at all.

Dental indemnity plans, which allow patients to seek dental care at any licensed provider with no concerns about networks. However, in exchange, patients typically always pay a percentage of the cost of a procedure (rather than having some treatments fully covered).


Dental and Medical Insurance: Two is Better than One

Maintaining separate medical and dental insurance can seem like a hassle, but the reality is that you probably don’t want your dental care to be covered under medical insurance. When dental is wrapped with medical, costs tend to go up; you’ll probably have a much higher deductible (in the thousands rather than the hundreds), while restrictions limit accessibility of care (usually only children get free preventative dental care). Patients also see a greater variety in provider choice when they uncouple their dental care from their medical insurance-mandated dentist network.


Alternatives to Traditional Dental Insurance

Visiting an Out-of-Network Dentist

Medical insurance can be intimidating with its strict adherence to in-network facilities. However, visiting a dentist out-of-network isn’t the same as trying to see an out-of-network medical doctor. For dental insurance, “out-of-network” doesn’t mean you aren’t allowed to see an out-of-network dentist. Your PPO plan can still cover out-of-network dentists, or the dentist themselves may offer a membership plan that is better than your insurance options. In addition, even plans that include out-of-network parameters can still cover up to a 100% of the cost of preventive services like cleanings. This can make care simple and improve outcomes, because you get to choose the specialist who is right for you—not the one your insurance plan dictates.

The determining factor for this particular component of dental insurance is the type of plan you choose–a cheaper plan may not cover as much regardless of who you see, limiting your choices, while a slightly higher-priced plan may offer significantly more coverage from more providers, whether in-network or out.


Dental Memberships

Dental memberships can be a simple, streamlined way to afford dental care. You’ll pay a fee (either every month or every year), and in exchange, you can receive the dental care you need at low or no cost. Preventative treatments are usually free with a dental membership, and if you need more in-depth treatments, you’ll receive a discount. Because they’re not partnering with insurance, dental offices that use membership plans can offer more competitive pricing.

With a Dental Health Membership Plan from Norman Smile Center, for example, one low annual membership fee includes:

  • Personalized advice on the services that are best for you.
  • Access to all of our services.
  • No waiting periods so you can get the treatment you need when you need it.
  • Preventive and comprehensive care benefits, including exams, cleanings, and unlimited digital x-rays. Additionally, each period includes one complimentary emergency exam. 
  • Discounts on many dental services, even cosmetic ones like whitening trays.
  • Transparent and easy payment processes instead of premiums, copays, deductibles, and reimbursement claims.


Discover Affordable, High Quality Dental Services at Norman Smile Center

At Norman Smile Center, we’re committed to helping our patients receive the quality, comprehensive dental health services they deserve at a price they can afford, so we do everything we can to make paying for that essential care less painful on your wallet. The many dental insurance plans we cover can be complemented with our array of payment and financing options, or you can bypass insurance altogether for one of our Dental Health Membership plans. Not sure? Our friendly and experienced staff can help you navigate the nuanced world of paying for dental care and help find the solution that’s right for you and your budget.

Your oral health is important, and at Norman Smile Center, it’s our top priority. From the latest in precision dentistry, digital imaging, and diagnostics to our all-women team of dental professionals, Norman Smile Center can help you discover your healthiest, most beautiful smile without breaking the bank. Schedule an appointment today and receive a free bleaching tray!