Dental Insurance Basics: Breakdown Of What Is And Isn’t Covered

Insurance is one of those topics that can make people’s eyes gloss over, but as a patient with benefits, you really do need to understand at least the basics. Not being aware of your coverage can lead to frustration, financial stress, and unnecessary expenses. So keep reading to learn about the services dental insurance covers and how you can get the most out of your policy!

Preventive Services

Typical coverage: 80 to 100 percent

Although there are some exceptions, the strong majority of dental insurance providers cover the entire cost of preventive care. In fact, two checkups and cleanings per year should cost you nothing out-of-pocket.

Minor Restorative Services

Typical coverage: 70 to 80 percent

When a small problem is identified early, it can usually be resolved using tooth-colored fillings. Once the decay is removed, the composite resin compensates for the lost tooth structure before more extensive damage occurs. After insurance adjustments, you’ll be responsible for paying roughly 20 percent of the total cost of treatment.

Major Restorative Services

Typical coverage: 50 percent

If a dental problem requires more invasive treatment, the higher your cost will be. Major restorative services include root canals, dental crowns, bridges, and dentures. Insurance providers will likely contribute about half of the cost, leaving you with the other half to pay out-of-pocket.

Orthodontics

Many insurance plans include coverage for orthodontic care, but it’s a one-and-done opportunity that your provider will not pay for again in the future.

If you are interested in Invisalign, you’ll have to check your plan to see if clear aligners are covered.

Annual Maximums and Exceptions

Along with your normal coverage, you may need to be cognizant of some other features that could affect your costs, including annual maximums and exceptions like the “missing teeth clause.” Every calendar year, there is a limit to the amount your dental insurance provider will contribute to your oral healthcare costs. Once you pass $1,000 to $1,500, you’re responsible for paying the entire cost.

In addition, most plans will not pay to replace teeth that were lost before the policy began. In other words, if you had missing teeth before your plan started, the insurance company will not pay to replace it.

Why Dental Insurance Coverage Works This Way

You may be wondering about the reasoning behind the way dental insurance is set up. Why does most of the coverage focus on prevention and early treatment? Simply put, it costs much less—for both you and the insurance company—to pay for and prevent dental problems than it does to fix them later on. In fact, according to the University of Illinois College of Dentistry, every dollar spent in prevention results in $8 to $50 in potential savings!

If you still find insurance confusing, don’t hesitate to talk to your dentist and their office staff. They can explain your individual plan in greater detail and answer your questions.