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What Kinds Of Things Does Dental Insurance Cover?

Thursday, June 24th

What Kinds of Things Does Dental Insurance Cover?

Roughly 60 percent of the population in the United States has dental insurance coverage. The coverage is either provided through a comprehensive healthcare benefits package through an employer, or the individual has purchased a dental insurance plan on their own.

Either way, dental insurance coverage is rising in popularity. With the cost of dental care more expensive than the average consumer can afford, dental plans help to alleviate the financial burden on the patient, while at the same time, ensuring that the patient receives routine dental care which can help to keep their whole body in good health.

The American Dental Association recommends that a person have their teeth examined and cleaned at least twice annually by a dental professional. By doing so, the person is not only keeping their mouth clean and healthy, but also the rest of their body. Poor dental hygiene has been linked to other medical issues such as diabetes, heart disease and even some cancers.

But before purchasing a dental insurance plan, it is a good idea to compare the types of plans and the coverage each provides.

  • Preferred Provider Organization, or PPO. This type of plan offers a network of dentists who have agreed to accept payment at contracted rates from the insurer. PPO plans generally have a deductible that must be met prior to the insurer picking up any additional cost. Once the deductible is met, plans which reimburse 80, 90 or 100 percent of the cost are available. This plan will protect the patient by allowing them to know up-front how much they will be expected to cover out-of-pocket at the dentist each visit.
  • Discount Provider Organization, or DPO. These plans provide dental professionals who are willing to provide their services to patients at a discounted rate for a monthly or annual fee. This kind of plan generally does not include a deductible or payment plan; however, the patient will be responsible for the majority of the cost.
  • Dental Health Maintenance Organization, or DHMO. This plan is the dental equivalent to a medical HMO plan. DHMOs do not generally have deductibles, but rather use a co-pay system that determines the amount of money the patient will be responsible for paying at the time of service. Only dentists within the DHMO network may be used with this plan; otherwise, the patient will be responsible for the full out-of-pocket expense of the visit.

Now that we know about the kinds of plans available, let's discuss the kinds of services dental insurance subscribers can expect to be covered.

Typical dental insurance plans cover preventative and general diagnostic care 100 percent once a deductible or co-pay has been satisfied. Procedures such as root canals, bridges and oral surgery may be covered at anywhere from 50 to 80 percent. Most dental insurance companies will assign an annual maximum benefit to reimbursed services, ranging from $1,000 to $1,500.

The majority of dental insurance plans will not cover what are considered to be cosmetic procedures, such as orthodontics and tooth-whitening procedures.

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Dental Insurance Plan FAQ

If you already have dental insurance through your employer, you won't need to get coverage separately. But, if you're like the millions of Americans who don't have access to dental coverage through their job, it's worth it to consider buying a dental plan privately. Oral health is very important in your overall health, and twice-yearly checkups are recommended for everyone. Having dental insurance can make routine visits and services like root canals and cavity fillings much less expensive.
That will depend on the plan you choose, but most cover routine well visits like cleanings and X-rays. You'll also typically have coverage for fillings, crowns and other issues with your teeth; how much you'll pay out of pocket is based on your specific plan limits for each procedure and your total annual limit.
Many dental insurance plans don't cover removal of wisdom teeth or orthodontic treatments. However, coverage with higher premiums may include those procedures; if you've got multiple children in the family who might need them, it's worth finding a plan that pays for some or all of it.
You might be surprised at how affordable it is. Many individuals and families can get good coverage for less than $20/month.
You've got a lot of options. First, determine if you need individual or family coverage. Next, decide how quickly you want your dental insurance to start: some let you begin your plan on the same day, while others may have a delay of a few days or more. Then, choose what level of coverage you need and select the dental insurance plan that fits your needs and your budget!
Possibly. Most dentists accept insurance, but not necessarily all providers and plans. If you have a dentist you love, ask him or her which plans they take (and even which ones they like working with the most!); you can choose your insurance based on keeping your dentist.
As you might guess, dental insurance is traditional coverage that usually includes 100% of the cost of two preventative visits each year, lowers the cost of dental procedures, and often has an annual maximum dollar amount of coverage per year. Discount dental plans usually are lower in cost but give you less coverage: you may only save 10% on the standard cost for a filling or routine X-rays, and you will probably be limited to a single dentist instead of a network.
Absolutely. Most of today's most popular providers of dental insurance make it easy to pick a plan and pay for it online. If you don't have a specific dentist or insurer in mind, you might want to try using a referral site that gives you quotes from multiple companies and lets you compare your options side-by-side.
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