What Does Your Dental Insurance Plan Cover?

Whether you have an individual plan or one through your employer, dental insurance makes taking care of your teeth an obvious choice for your oral health and your wallet. However, far too many patients are unfamiliar with their policy, resulting in wasted benefits and unused dollars at the end of each year. To prevent that from happening to you, here’s a basic breakdown of what insurance providers do and don’t cover.

What Does Dental Insurance Cover?

At its core, dental insurance is a prevention-based plan designed to catch oral concerns early on, prevent dental emergencies, and ward off decay. With this in mind, most are centered around a “100-80-50” structure. This sequence refers to 100% of regular preventive care, 80% of basic treatments, and 50% of major procedures being covered by your carrier. However, some policies also include additional benefits, like a percentage toward orthodontic treatment, so make sure to contact your insurance company for a full explanation of your coverage.

What Doesn’t Dental Insurance Cover?

Although each dental plan is unique, most don’t cover cosmetic dentistry procedures since they aren’t considered medically necessary. A few common examples of these treatments include teeth whitening and porcelain veneers. That being said, there are a few services where cosmetic and restorative care intersect, like metal-free restorations, which may be covered by your plan. So, never hesitate to ask!

A Few Terms to Know

• Deductible – Like auto insurance, this is the out-of-pocket cost you are responsible for paying before your benefits kick in.
• Annual maximum – This is the highest dollar amount your provider will put toward your treatment within a benefit period, which is typically one year.
• Waiting period – This is the time you must wait until the coverage for a certain treatment becomes available. So, if you have a three-month waiting period for root canals, then you will need to wait that long until you are eligible for coverage.
• Treatment limitations – Depending on your plan, you may have certain procedures that can only be completed a certain amount of times per year. For instance, oral exams are usually only covered every six months.

As the end of the year rapidly approaches, there is no time like the present to look into the fine print of your dental plan. That way, you can utilize your coverage to the fullest and head into the new year with a strong, healthy, beautiful smile!

About the Author

After completing his undergraduate degree at Boston College in Chestnut Hill, Dr. Jonathan Aguilar earned his dental doctorate at Texas A&M Health Science Center Baylor College of Dentistry. Today, he enjoys using his extensive education and genuine passion for dentistry to work one-on-one with patients, so they can get the high-quality care they deserve without breaking the bank. In fact, Aguilar Family Dentistry accepts all major PPO dental insurances and will file the paperwork on your behalf! So, if you have any questions about utilizing your dental plan to the fullest, visit his website or give him a call at 940-566-5332.