Although many Americans have dental benefits, usually provided by private insurance through an employer or group program, they often don’t understand exactly what their coverage covers. While plans differ, there are some things you should know about dental insurance in order to make the most of your benefits. What does dental insurance cover? Scroll down to find out.
What Does Dental Insurance Cover?
As we noted above, coverage varies from plan to plan.
Typically, all dental insurance plans cover routine and preventive care, including twice-yearly dental cleanings and exams and annual x-rays. Often, 100 percent of the costs are covered.
In addition, most plans cover some portion of the cost of the following procedures:
- Simple tooth extractions
Finally, some plans also cover some portion of the following procedures, but others do not:
- Root canals
- Oral surgery
- Orthodontics (like braces, palatal expanders, and separators)
- Periodontics (like scaling, root planing, and gum grafts)
- Prosthodontics (like dentures, implants, and bridges)
- Cosmetic procedures (like teeth whitening, bonding, and veneers)
- Pre-existing conditions (i.e., any condition you had before you got your dental plan)
While we use the term “cover,” it’s important to understand that dental insurance often only covers a portion of dental care. Many plans use a 100-80-50 form of coverage, which means that they cover 100 percent of preventive care (routine cleanings, x-rays, etc.), 80 percent of basic procedures (fillings, tooth extractions, etc.), and 50 percent of major procedures (crowns, bridges, dentures, etc.), but plans can differ dramatically. This is why it’s important to carefully review the details of your specific plan’s coverage.
Note that sometimes you will need to pay a deductible before your insurance coverage kicks in. In addition, every plan has an annual maximum, which is the total amount the insurance company will pay for your dental care each year. Once you reach that amount, you are responsible for all the costs that go above it. In addition, some insurance plans provide lifetime maximum benefits for certain dental work. For example, this is often true of braces. Even if your insurance covers some portion of the cost of braces, they may (1) only pay for braces one time and (2) only pay a certain percentage of the total case fee.
Dental coverage can be complicated, so don’t hesitate to ask for more details about your coverage through your insurance provider or your dental team. In addition, you might find it helpful to check out our blog post Dental Insurance vs. Health Insurance. Finally, if you don’t have dental insurance, consider exploring a dental discount plan.
If you’re looking for an experienced, reliable, and friendly dentist near Springfield, Missouri, contact Wilkinson Dental. Dr. Wilkinson and his team will give you the personalized treatment you deserve using state-of-the-art technology.
We submit to all insurance companies, though we are a preferred provider of Delta Dental, MetLife, and Cigna. Even if we’re considered “out-of-network” by your insurance provider, we will still submit to them on your behalf. In addition, we’re happy to provide all patients with a comprehensive “benefits breakdown” prior to their first appointment. Our team will work with your insurance company to ensure that you have the most accurate and up-to-date information available, and we will process your claims to ensure that you receive the maximum benefit your insurer is willing to pay. We understand how confusing and frustrating insurance coverage can be, and we promise to help you figure out how your benefits, co-pay, and deductible will impact your bill. Don’t hesitate to contact us if you have questions about your coverage or our payment options. And if you don’t currently have dental insurance, consider signing up for the Wilkinson Dental Discount Plan.
For exceptional and comprehensive dental care, schedule your first appointment today by calling 417-708-0556 or requesting an appointment online. We look forward to hearing from you!