HOW MUCH DOES MY DENTAL INSURANCE COVER?
Dental insurance plans can help defray the costs of treatment, but it can be tricky to navigate what’s covered and what’s not. In other words, how do you make the most of a dental plan?
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.
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.
Not all dental plans are created equal, but a standard employer-provided PPO should cover between 80 and 100 percent of the cost for treatments like regular checkups, cleanings, fluoride and sealants. More critical work such as root canals or fillings are covered at anywhere from 70 to 80 percent, while major work like crowns or dentures typically come in at 50 percent coverage.
You also need to bear in mind the cost you’ll pay for each service. Dental plans come with a deductible each time you make a claim, which can range from $50 to $100. It’s possible to lower the amount you pay per month by increasing the amount of your deductible and visiting the dentist only once per year, but you run the risk of a huge bill if you suddenly need treatment. In addition, most plans have a maximum payout each year, often between $1000 and $2000. This seems like a substantial amount until you consider the costs of treatment: A periodic oral examination costs less than $100 on average, but a crown can cost between $700 and $800, while fixing a molar costs at least $600. As a result, your plan can quickly cap out.
Dental insurance plans typically have “tiers” of coverage, starting with basic options meant to cover the average expenses associated with hygiene. Your employer (or you, if you’re going to bear the entire cost of insurance) can opt for orthodontic coverage, which includes more expensive options like braces, casts and referrals to orthodontic specialists.
Generally speaking, cosmetic dental procedures are NOT covered under any insurance plan, especially one managed by an employer. If your dentist can make the case for medical necessity, it may be possible to have treatments such as dental veneers covered, but depending on the percentage and deductible, it may not be worth the cost.
Making the most of dental insurance
To make the most of your coverage, you want to roll as many services into a visit so you only have to pay a single deductible. Do this within reason, of course – a REPUTABLE DENTIST should be able to deal with most of your dental needs in a relatively short period of time, saving you money in the long run. In addition, make sure to check with your employer about how much you’re paying per check for your insurance. In some cases, the amount deducted amounts to more than the total coverage offered, meaning you may want to opt out.
Anyone exploring dental coverage may want to consider forgoing traditional insurance in favor of an alternative: a discount dental plan. You pay an annual fee to receive certain services at a set rate or at a discount. ASK US ABOUT THIS OPTION.