What Does Your Insurance Cover?

The type of insurance you have will affect the extent of dental care cover. Medical insurance that includes dental benefits could be convenient but may have limitations. In contrast, a direct dental insurance plan offers flexibility and more coverage options. Here are the dental care procedures that insurance may cover:

  • Preventative care: Includes routine office visits and professional dental cleaning.
  • Basic Restorative care: For dental treatments like fillings and crowns.
  • Endodontics: For root canals.
  • Oral Surgery: Tooth extractions, tissue biopsy, drainage of bacterial infections, and placement of dental implants.
  • Orthodontics: Palatal expanders, braces, aligners, and retainers.
  • Periodontics: Scaling, root planing, gum grafting, periodontal surgery, and placement of implants (if certified for implant placement).
  • Prosthodontics: Dentures, bridges, and dental implants

According to the National Association of Dental Implants, these procedures are categorized into three groups of coverage for payment purposes: preventative care, basic procedures, and major procedures. Generally, insurance plans will cover 100% of preventative care. Basic dental treatments like tooth extractions, fillings, root canals, and gum disease treatment may be covered at a lower rate, approximately 80% or less. Dental crowns, dentures, and dental implants are major procedures that tend to be covered at the lowest percentage, such as 50%. It is common for dental insurance plans to have a waiting period, typically a year or less, before covering major procedures like dental implants. Be sure to speak to your insurance provider to find out about the waiting period and if they cover major dental procedures such as implants.

Types of Insurance Plans

When looking to get dental insurance, you will have to consider the type of plan that best suits you. Dental Maintenance Organization (DMO) and Dental Preferred Provider Organization (PPO) are the two most common types of plans. Dental HMO plans are a lower-cost option; you can choose your primary care dentist and need a referral from your primary care dentist to go to a dental specialist. In a PPO plan, you do not need a referral to a dentist, and the costs are lower if you select a dentist in the network. A Dental Indemnity Plan is another type of insurance plan that allows you to visit any licensed dentist in your state or the United States. A referral to the dentist or dental specialist is not needed.

What are the Other Options?

If you don't have any insurance, now might be the perfect time to find a plan that fits your budget. Dental insurance can cover regular dentist visits, which are vital for good oral health. It also helps minimize the cost of more extensive procedures like dental implants. But what happens if you can't afford insurance? You can speak to your dentist about alternative financing; they may suggest a payment plan option where the cost is divided into installments. Your dentist could also get you in contact with organizations that offer financial payment plans (Care Credit) for oral care treatments.

Having missing or decayed teeth can make you feel self-conscious about your smile. Luckily, dental implants are a treatment option that can give you a natural smile. While the procedure's cost may seem daunting at first, a good dental insurance plan can assist in covering the cost. Be sure to check if your current medical insurance or dental insurance includes dental implants. If you have had the plan for over a year, you might be pleased to find out that it does!

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider.

ORAL HEALTH QUIZ

What's behind your smile?

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DO YOU KNOW?

2.3 billion

people worldwide suffer from tooth decay

ORAL HEALTH QUIZ

What's behind your smile?

Take our Oral Health assessment to get the most from your oral care routine

DO YOU KNOW?

2.3 billion

people worldwide suffer from tooth decay