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What is (and What is Not) Covered Under My Dental Insurance ?

What Does Insurance Cover

Whether you have dental insurance or not, it can be a confusing topic. There are many vocabulary terms and types to choose from that all cover different things. Here is a breakdown of what you can expect from a typical dental insurance policy.

What are Your Insurance Options?There are three main kinds of dental insurance plans: HMO, PPO, and indemnity.

HMO (health maintenance organization) plans are those which require you to choose a dentist from a limited network of health providers. If you visit a dentist who isn’t in the HMO network, your dental care isn’t covered by the insurance.

PPO (preferred provider organization) plans don’t require you see a network dentist in order to be covered. However, you can expect to pay more out-of-pocket costs if you see a dentist who isn’t in the network.

Indemnity plans aren’t associated with a network. That means you receive the same level of coverage no matter which dentist you see. However, these plans are typically more expensive overall than both HMO and PPO plans.

What’s Included in a Dental Insurance Policy?

The most common kind of dental insurance is a variety called 100-80-50 insurance. This term refers to the levels of coverage the insurance provides for various kinds of dental services.

Generally, this kind of insurance covers the following:

  • 100% of the cost of procedures relating to routine dental care or preventative care; for instance, this includes routine checkups and cleanings. A typical dental insurance policy covers two checkups a year.
  • 80% of the cost of basic treatment procedures such as fillings and root canals.
  • 50% of the cost of crowns, bridges, and other major treatment procedures.
  • Dental policies have a deductible. This means you pay a certain amount out of your own pocket before the insurance kicks in and covers the rest. In general, the lower your deductible, the higher your premiums will be.
  • Most policies also have an annual benefit limit. This means that once you reach the benefit limit, any further dental visits in that year aren’t covered by the insurance. Some policies allow you to raise the annual benefit cap by paying a higher premium.

What’s Not Covered by Dental Insurance?

As with most types of health insurance, the procedures that aren’t covered include anything that’s carried out for cosmetic reasons. For instance, insurance doesn’t cover veneers or teeth whitening. In addition, few dental policies cover orthodontic procedures.

Note also that dental insurance policies don’t cover pre-existing conditions. This means any dental health problems you have at the time of getting the insurance may not be covered. Many policies also have a waiting period of up to 18 months. During this waiting period, the policy won’t cover major dental procedures.

In some cases, health insurance covers dental work. This is typically in situations where the dental work is considered to be “medically necessary”. For instance, if you need oral surgery because you were injured in an accident, your health insurance may cover the costs of the procedure.

Safeguarding Your Oral Health

Good oral hygiene is not always enough to make sure your teeth and gums stay healthy and functional for your entire life. Even if you brush and floss every day, you may still be at risk of gum disease, cavities, and other problems. And there’s always the risk of accidental injury to your teeth or gums, which typically requires professional dental treatment.

Regular dental visits are definitely important to ensure you maintain good oral health over the course of your life, and dental insurance is a useful way to keep the costs of dental care down.

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