What Does Dental Insurance Typically Cover?
It can be overwhelming when enrolling in benefits to determine what you need for dental coverage. Dental insurance covers many services, from cleanings, exams, and X-rays to more extensive services like crowns, bridges, or dentures. But what about braces, teeth whitening, or veneers?
While the terms and details on dental plans can seem confusing and complex, it’s important to know the basics of dental insurance so that you can find the right plan for you (and use it to its full potential!). Continue reading to find out more about what dental plans typically cover.
Class Breakdown
A dental insurance plan typically covers services according to a class breakdown. Each class is listed below.
Class I: Preventive, including exams, cleanings, and X-rays.
Class 2: Basic fillings, extractions
Class 3: Major crowns, dentures, implants (if covered)
Class 4: Orthodontic (may have age restrictions if covered)
How are Different Dental Classes Covered?
Typically for preventive services, the plan will cover 100% of the cost associated with these services. For basic services and major services, the plans will often have an individual or family deductible that must be paid first, then will go to a coinsurance-based cost share. Typically this is 80% coverage for basic services and 50% for major services (but this can differ amongst carriers and plans).
Dental plans will often have a maximum amount that the plan will pay out per year. If the plan covers orthodontic treatment, it will often have a separate deductible and a lifetime maximum for these services.
What Does Dental Insurance Usually Cover?
In general, a dental plan will cover the majority of services that are needed to help keep your teeth & mouth healthy. These services are often included in the classes defined above.
Does Dental Insurance Cover Veneers?
Typically most dental plans do not cover veneers as they are often considered cosmetic. You would want to check with your plan document to see if they are allowed and if there are criteria for them to be covered.
Does Dental Insurance Cover Crowns and Crown Replacement?
Yes, crown installation and replacement is typically covered on dental plans. Usually, plans will have a 5-year replacement clause that states you must have the crown, denture, bridge, or appliance for five years from the seat (a.k.a. installation) date before it can be replaced.
Does Dental Insurance Cover Braces?
Many plans will cover braces under their own class of coverage. This is normally covered as a major service and may have its own lifetime maximum tied to the benefit. You would also want to check with your plan to ensure there are no age restrictions for orthodontic treatment, as some plans will only allow up to age 19.
Does Dental Insurance Cover Wisdom Teeth Removal?
This can be tricky. Oral surgery is either covered under the dental or the medical plan, depending on medical necessity. You would want to check with your plan documents to confirm how it would be covered. There are also situations where both medical and dental plans may cover the procedure.
For example, the dental plan may cover only the dentist fees for wisdom teeth removal while the medical plan may cover a portion of the cost of anesthesia required, if you meet the criteria for coverage.
Does Dental Insurance Cover Teeth Whitening?
Dental insurance does not normally cover teeth whitening, since it’s typically considered cosmetic in nature.
Why Do You Need Dental Insurance?
Dental coverage is good to have for routine preventive and basic services, but will also provide you with protection for the more extensive services if needed. Regular dental exams ensure that a professional can take a look at your teeth and gums to identify issues and prevent them from getting worse (and more painful). This is beneficial for your health and wellbeing and could help prevent costly services in the future.
What are the Most Common Types of Dental Plans?
Most dental plans are either DHMO or DPPO plans.
DHMO plans require you to select a primary dentist. This is the dentist who will coordinate all your treatment. If it's something that they can’t do, they will refer you to someone in your network that can do the treatment.
PPO plans give you more flexibility to go to who you want. You can go to a general dentist or a dental specialist with no referral required. However, similar to medical plans, you do want to stay in the dental network to optimize the discounts available to you and keep costs at a minimum.
Keep in mind that it’s always best to stay within the dental network for the most cost savings as a customer. Most dental plans are willing to do a pretreatment estimate to help you understand exactly what you will be responsible for before obtaining treatment.
Are There any Exclusions/Waiting Periods on Dental Coverage?
There can be waiting periods or exclusions on dental plans. Your plan may cover preventive and basic services but impose a waiting period for major services. This often will be for more extensive work like crowns, bridges, dentures, or even orthodontic treatment. The waiting period may last for a year or longer before these services are covered under your plan.
Now that you’ve reviewed the basics of dental insurance coverage, hopefully, you feel more confident when enrolling in a plan and using your insurance!
