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What Does Dental Insurance Typically Cover?

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One of the most frequent questions about dental insurance is, “What does this insurance cover?” It is difficult to answer this question with specifics, because every insurance provider offers a slightly different kind of coverage. Luckily, there are a few basic guidelines that apply to most dental plans.

What Is Typically Covered:

Most dental plans will cover your care with different co-pay levels, which means that some procedures may be fully covered by your plan, while other procedures may require you to pay a part of the cost.

•    Diagnostic and preventive care – Most dental plans cover these procedures completely or require only a small payment from the patient. Diagnostic and preventive care typically includes checkups, X-rays, routine cleaning, fluoride treatment, and other procedures that detect or prevent tooth and gum disease. The list of procedures that falls into this category varies by provider; for example, a dental plan might consider fluoride treatment a “basic procedure” and require a larger co-pay.

•    Basic procedures – Many dental plans cover these procedures with a small co-pay. Basic procedures include tooth removal, cavity fillings, gum care and repairs to cracked or chipped teeth. Some providers even include surgeries such as root canals in this category.

•    Major dental care – If you expect to need major dental care, review your provider’s plan carefully to find out whether it will be covered. If it is covered, there may be a waiting period before the provider will cover the cost of the care. For example, dentures might not be covered until you have had your plan for at least six months. Procedures that fall into the category of major care can include surgery, braces, implants and dentures.

What’s Not Covered:

It is very rare for a dental insurance plan to cover cosmetic procedures. For example, porcelain tooth veneers, tooth whitening or bleaching, and tooth bonding (to close gaps in teeth) are usually not covered by dental insurance.

Orthodontics (such as braces) are not covered by most plans, but it is possible to find a dental plan that covers braces. If you are considering braces, check with your insurance provider to see if some or all of the cost will be assumed by the provider.

Helpful Hints:
As you choose an insurance provider, there are a few important tips which will help you navigate the confusing variety of dental insurance plans.

•    “Full insurance coverage” does not mean that the plan covers everything that could ever happen to your teeth. It simply means that the plan covers more procedures than a cut-rate dental plan might cover.
•    Some plans require that you use a dentist in their network. If you want to keep your current dentist, ask if he or she is included in the list of acceptable dentists.
•    Some plans cover lots of procedures, but limit the maximum monetary benefit to a small amount per year.
•    Even the worst dental bills rarely exceed the cost of the highest medical bills. For example, an implant to replace a broken tooth would typically cost less than chemotherapy for cancer. For this reason, some patients “insure” themselves by saving money for emergencies instead of paying for dental insurance coverage.
•    If you have to pay cash for a dental procedure, ask your dentist if there is a discount for paying the cost of the procedure up front. Many dentists are glad to lower their fees, because they save money by not filing insurance paperwork.

The range of options with dental insurance plans can be overwhelming. Read your dental plan carefully to see what is covered, or call your insurance provider if you have questions about a specific procedure.
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