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      June 26, 2019

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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, letís 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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