About 80% of the American population has some type of dental insurance. There are all sorts of different insurance companies and policies that they offer. Plus, they include very specific terms to the insurance world, making it a little bit hard to understand for the average person.
One of the most important things to understand about insurance is what you are covered for. This can help eliminate any financial surprises when you get to the dental office.
What does dental insurance cover? Read on as we explore dental insurance coverage!
Types of Dental Insurance
Before talking about what dental insurance covers, it’s important to understand that each plan may be different. There are several types of dental insurance plans.
Some plans cover more than others. You’ll pay a higher monthly fee, or premium, per month for these plans.
Generally, there are three major types of dental work. This includes preventative, basic, and major dental procedures.
Preventative Care
Preventative care includes things like dental x-rays, teeth cleanings, exams, and sealants. Most insurances cover a new set of x-rays every two years unless there is some need for them before then. Cleanings are general done twice a year and are also most often fully covered. At every cleaning, you’ll also have an exam which should be covered.
Services that are considered preventative care may be completely covered. A common Prefered Provider Organization (PPO) structure is 100/80/50. This signifies that 100% of preventative care would be covered. However, some plans offer 80% to 100% coverage of these.
Basic Dental Care
Basic dental care includes tooth extractions and fillings. Basic services are usually covered at a 50% to 70% rate.
There are some restrictions when it comes to fillings and extractions. This often includes a six-month waiting period and a cap on what they will pay per year. You might also need to make multiple visits because of the cap on how many you can get in one visit.
Major Dental Procedures
A major dental procedure is usually a more serious issue. This could be a root canal, dental crown, dental bridge, or dental implant. These types of procedures usually near the $1,000+ mark. You might expect about 50% of coverage.
There are also restrictions on these procedures such as a 12-month waiting period.
Orthodontics
Orthodontics is not usually covered by a dental plan for those who are 18 years or older. Children, however, may be partially covered in certain circumstances. Braces are a common treatment used with about 4 million Americans wearing them.
Supplemental plans are available for purchase that cover orthodontics.
What Isn’t Covered?
The most common procedure in question would be cosmetic. Because there is no health need for these types of procedures and they are purely a choice, they are likely not to be covered.
Pre-existing conditions may raise questions as well.
What Does Dental Insurance Cover?
So, what does dental insurance cover? There may not be a straight answer. Truly, it is up to your plan what is covered and how much. If you have questions about your coverage, you can always contact your provider to find out more.
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