Dental Insurance: What's Covered and What's Not

The world of health insurance is constantly changing - and the average consumer struggles to keep up with shifting coverage and policy changes. Like your health insurance, dental insurance is a crucial piece to maintaining your oral health. Having coverage allows you to receive affordable, preventive care and avoid more severe problems resulting from not seeing the dentist regularly. 

Your general dentist and their team can help you understand exactly what kind of coverage you have under your policy and what you can expect your out-of-pocket costs to be for routine treatments. This will allow you to comprehend your dental coverage better, especially if you have an upcoming procedure requiring some budgeting and planning.

Dental Insurance Coverage Explained 

Your dentist is the first line of support when attempting to decipher insurance benefits. While dental insurance can quickly become confusing to you, the staff at your provider's office works with different dental insurance plans every day. They can aid you in deciphering what treatments you are covered for and what out-of-pocket costs you can expect. 

Your provider may also be able to assist you in getting an allowance towards the cost of a procedure that's not explicitly covered in your insurance plan. This can help you put the money you would have gotten for one procedure, such as a bridge, towards a similar product like an implant. 

Your dental office is your best resource for getting the most out of your coverage. Many providers offer payment plans that allow patients to make payments over time, so issues don't go untreated and become more significant problems. 

Typical Dental Insurance Benefits

When it comes to how you view your dental insurance, the best piece of advice is to look at your policy as more of a "discount card." Dental insurance is very different than a traditional insurance policy like many have for a car or a property. 

Dental insurance is structured as a way for employers to help their employees offset some of the costs of dental care and to maintain optimal dental health through routine exams and cleanings and not for covering the entire costs of procedures. 

Basic Dental Coverage

Every dental insurance policy is different in what it covers; however, a standard employer-provided PPO should cover between 70 and 100 percent of the costs for treatments such as:

• Routine checkups
• Teeth cleaning twice a year
• Fluoride treatments for children under a specified age
• Sealants for children under a specified age
• Root canals
• Fillings

Out of Pocket Procedures 

Dental insurance plans typically have tiers of coverage, with basic options to cover the ordinary preventative expenses associated with your oral hygiene. Based on the type of coverage you have selected, your insurance may also cover a certain percentage of more extensive procedures such like:

• Orthodontic coverage for braces
• Referrals to orthodontic specialists
• Crowns
• Bridges
• Partial Dentures
• Veneers

Always Try To Stay In-Network When Possible

Most PPO dental plans have outlines for fee reductions when a patient has services rendered by a participating network provider. The participating providers have already agreed to an itemized fee schedule with your insurance provider. Most covered services have fee reductions from 10-35% off the regular fee when you stay "in-network." 

Preventive Care Makes a Big Difference In Your Oral Health 

The number one way you can save money on dental care is to maintain excellent oral health. Going to the dentist for routine dental exams and cleanings at least twice a year will help identify any issues while still minor and easily fixed. By scheduling routine exams, you stay on top of potential problems and nip them in the bud before becoming more significant problems that your insurance will not cover. 

Always practice good oral hygiene at home, follow your dentist's instructions for maintaining oral health, avoid gum disease, and prevent cavities by maintaining a healthy and balanced diet. 

If you have questions on how to make the most of your dental insurance benefits, ask our team at Elite Dental & Denture PC to review your coverage details with you.