A version of the question, “Will my insurance cover this?” is asked in every dental office around the country every single day. Of course, people want to save as much as possible on their care, but the problem is that most plans can make it quite tricky to know what exactly they will (and will not) pay for. Thankfully, this quick guide can help you look past the fine print and get the information you really need before you head in for your next visit.
The Structure
The vast majority of dental insurance plans in the U.S. follow what is called the “100-80-50” structure, which tends to look something like this:
- Preventive services (checkups, cleanings, X-rays, fluoride treatment) are covered 100%
- Basic restorative services (fillings, bonding) are covered 80%
- Advanced restorative services (crowns, bridges, dentures, extractions) are covered 50%
It’s important to keep in mind that each individual plan will differ when it comes to how it categorizes a treatment. Plus, you’ll probably have to meet a deductible before you can gain access to these rates.
Also as you might have noticed, cosmetic treatments (whitening, veneers) are NOT covered because they are elective procedures.
Special Cases
Dental insurance can also be used to help pay for specialty procedures like periodontal therapy (gum disease treatment) and orthodontics.
With periodontal therapy, it might be given its own category and receive a unique level of coverage. Insurance providers often have plans that are specifically designed to help those who require prolonged gum care, and the structure of the coverage isn’t as standardized as above.
But with orthodontics, it works a little differently. Each person covered by a plan receives a lifetime benefit (i.e. a pool of money) that can be applied toward orthodontic treatment. This can be used for braces by all plans and sometimes clear aligners like Invisalign as well. Once the money is spent, it doesn’t come back.
Don’t Assume!
While your dental insurance plan may have similar terms to this, never assume you’ll be covered for a service before you have talked to either your insurance provider or the practice you wish to visit. Things like annual maximums, deductibles, and missing tooth clauses can further complicate things.
Hopefully, you have a much clearer idea of what your dental insurance actually covers, and if you’re even more confused than when you started reading this, don’t worry—just reach out to your local dental team, and they’ll be happy to answer all of your questions.
About the Author
A Burlington native, Dr. James P. Kostas is thrilled to serve the dental needs of his hometown! His practice is pleased to offer a wide range of available services including preventive, cosmetic, and restorative options. He also understands the importance of keeping dentistry affordable, so his practice accepts many insurance plans, offers flexible financing, and even has an in-house savings plan. To learn more about how you can spend less and get more at the dentist, contact us today.
