Let’s hop into the dental time machine.

It’s the early 1990s.
Porcelain-fused-to-metal (PFM) crowns are considered cutting-edge.
Gold crowns are still a flex.
And dental insurance proudly advertises an annual maximum of $1,000.

Now fast-forward to today.

Dentistry has evolved. Materials have improved. Labs are more advanced. Overhead has exploded. Wages, supplies, technology, and compliance costs are all significantly higher.

And dental insurance?

Still hanging out in the $1,000 to $2,500 annual maximum range, just vibing like nothing has changed.

The Great Disconnect

Here’s the part that frustrates patients and dental teams alike:

• Dental insurance annual maximums have barely changed in 30+ years

• Meanwhile, the cost of delivering high-quality dentistry has increased dramatically

• One major procedure can easily consume an entire year’s worth of benefits

Most policies today will:

• Cover two cleanings and exams

• Help a bit with a filling or two

• And then tap out once a single crown enters the chat

One crown, whether PFM, gold, or another restorative option, can max out the patient’s benefits for the entire year. After that, insurance politely disappears until January 1st rolls around again.

Why Haven’t Maximums Increased?

Because dental insurance was never designed to function like medical insurance.

Dental plans originated decades ago as a cost-sharing benefit, not true insurance against major financial risk. Think coupon system, not safety net. That’s why:

• Preventive care is emphasized

• Major procedures are limited

• Annual caps are rigid

• And once the cap is hit, the patient is fully responsible

This isn’t a glitch. It’s the design.

About Those “High” Maximums Everyone Talks About

You may hear rumors of plans with $3,000 to $5,000 annual maximums, spoken about in hushed tones like dental folklore.

Let’s be clear and factual:

• $5,000 annual maximums are exceptionally rare

• They are typically associated with retired military benefits or individuals who served in very high-level, specialized government or military roles

• These are not employer-sponsored dental plans

To date, seasoned insurance professionals will tell you they have not seen standard employer plans offering a $5,000 annual maximum. If someone claims otherwise, it’s worth asking to see the policy, slowly, carefully, and with snacks.

What This Means for Patients

Patients often believe:

“I have dental insurance, so this should be covered.”

What they actually have is:

“I have a limited annual allowance that hasn’t kept pace with inflation since the first Bush administration.”

This misunderstanding leads to frustration, delayed care, and shock when treatment plans exceed what insurance is willing to contribute.

What Dental Teams Can Do

Education is everything.

• Explain annual maximums early

• Show patients how one procedure can exhaust benefits

• Help patients plan treatment across benefit years when appropriate

• Reinforce that insurance is not a treatment plan, it’s a financial tool

The Bottom Line

Dental insurance maximums are stuck in a different era, one where PFM crowns were revolutionary and $1,000 actually went a long way.

Dentistry has evolved. Insurance largely hasn’t.

Understanding that reality helps patients make better decisions, helps practices avoid uncomfortable conversations, and reminds everyone that quality dentistry has value, even when insurance refuses to acknowledge it.

Jody Lujan
Client Success Architect – Veritas Dental Resources, LLC