Understanding Dental Health Insurance; Affordable plan for treating your Oral Cavity


“Deamonte Driver, a 12-year-old boy from Maryland who died from an untreated tooth infection that spread through his brain. His family did not have dental benefits, and he ended up being rushed to the hospital for emergency brain surgery, which wasn’t enough to save him.”- story from ‘Teeth; The story of Beauty, Inequality, and the Struggle for Oral Health in America’ by Mary Otto.

Whether you have health insurance is one thing, whether you have dental insurance is another. Your doctor doesn’t ask you if you’re flossing, and your dentist doesn’t ask you if you’re exercising. Dentist treat your teeth and oral vessel and physicians look at the body from the tonsils south.

Health has been declared as fundamental human right. Oral health is an integral part of general health and, can be rightly called as the gateway of the body. The prohibitive cost of dentistry has been the main hindrance which deprives people of availing the services.

Introduction to Dental Health Insurance

During the years after World War-II, when medical insurance was growing rapidly, dental care was one of the “fearful” four areas of health care(dental care, psychiatric care, prescription drugs, and long-term care) considered uninsurable by carriers. This reasoning was based on the assumption that the very nature of dental need violated the basic principles of the insurance. All health insurance violates some of the principles of insurance.

Individual dental insurance works on your selected plan based on the providers(dentists) you want to be able to visit and what you can afford to pay.

  • If you already have a dentist you like and they are in the insurance company’s network, you’ll be able to opt for one of the less expensive plans.
  • If you don’t have a dentist at all, great! You can choose from any of the dentists who are in-network and again have the option of a less expensive plan.
  • If your existing dentist is not in the network, you can still get insurance, but you’ll pay significantly more to see an out-of-network provider-so much more that you may not have any chance at coming out ahead by being insured.

The monthly premiums will depend on the insurance company, your location and the plan you choose.

Different types of payments offered by the insurer are


It is stipulated flat sum that the patient must pay towards the cost of treatment before the benefits of the program go into effect. It is sometime called “front-end-payment”.


It is also called as “co-payment”. It means that the patient pays a percentage of the total cost of the treatment. Insurance carriers limit the range of health care services covered. This is termed, “limitation of benefits”. Co-insurance helps keep premium down.

Group Insurance:

This is health insurance offered only to groups. This is because illness experience is reasonably predictable in a group.

Possibilities in our context

In the underdeveloped and developing countries like Nepal, dental insurance is still a high reach fruit. People here don’t give health insurance a proper acknowledgment and to install ideas about dental insurance seems difficult. Health/dental insurance has become necessity of the time these days.

Tell trying this to the people and many would ask; why? The main reason you should opt for a dental insurance is the escalating cost of the treatment. Illusion of not being prone to illness, lack of awareness, unaffordability and non-prompt claims are the discouraging factors from both side.

Economic growth of a country depends on the empowerment of people, which is highly reliant on the freedom they enjoy from poverty, hunger, malnutrition, and freedom to work which ultimately leads to healthy and productive life. Thus, health care becomes a fundamental necessity for human well-being.

Oral health is central to a person’s overall health, rightly called as the gateway of the body. Oral diseases restrict activities in school, at work and at home causing millions of school and work hours to be lost each year worldwide. Moreover, the psychosocial impact of these diseases often significantly diminishes the quality of life.

Despite great achievements in the oral health of populations globally, problems still remain in many communities around the world – particularly among underprivileged groups, especially in developing countries. Although impressive advance has occurred in addressing communicable diseases, noncommunicable diseases are still emerging which are responsible for two-thirds of the total morbidity burden.

Dental diseases are one of the most common noncommunicable diseases, and dental treatment is considered to be the fourth most expensive treatment. The escalating cost of dental treatment has been an important barrier in the utilization of these services in developing countries.

People visit dentists only for curative services. We suffer disproportionately smaller health budget and the government spending on dental care is barely minimal or nonexistent. Consequently, people are forced to go to private providers, resulting in substantial out-of-pocket expenditures.

Thus, fee-for-service is still the major type of payment mechanism. The poor lack the resources to pay for it; they are far more likely to avoid going to care resulting in the further progression of dental diseases .

 To ensure the health protection of these working class individuals, health financing through social health insurance through mixed financing mechanisms – a combination of payroll contributions to include the middle class and formal sector workers and funds from general revenues of the government should be made. These schemes should  include expenses covered for dental treatment as well.

Unlike most western countries, specific dental insurance plans are not common in Nepal. Dental insurance is still far from its nascent stage. It is usually integrated with general health insurance schemes.

However, if dental insurance is made available, people would be more than ready for seeking preventive and prophylactic care, thus reducing the burden of oral disease and future expenses. It will also make dental treatment more affordable, proving to be a boon for one and all.

Arzoo Gupta

Dental student BPKIHS



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