Dental insurance comes in a variety of different types and levels of coverage. What type of plan you have will determine when and how you can use your dental insurance. You can usually use your dental insurance to pay for part of if not all of your preventative procedures and basic or restorative procedures when done by an in-network dentist. Some dental plans also provide coverage for major dental procedures. Before purchasing dental insurance, it’s important to understand what procedures are covered and what are not.
Today, most dental insurance is in the form of a PPO. PPOs provide clients with a list of specific dentists to choose from. Some plans only cover dental procedures that are provided by these preferred dentists, while others offer some reduced coverage for out-of-network dentists. DHMOs are another form of dental insurance. These plans typically do not allow you to see dentists outside of their network.
Most dental insurance plans can be used for preventative dental visits. Two visits a year are typically covered. Preventative procedures include cleaning, X-rays, check-ups, and fluoride treatments. How much of these procedures your dental insurance will cover varies, however. Some plans will cover 100% of these procedures, while other will cover around 80% and you will have to pay the difference in the form of a co-payment.
Basic or restorative dental procedures include fillings, in-office extractions, sealants, and usually root canals. Your dental insurance will usually cover around 80% of the cost of these procedures. It is rare to find a dental insurance plan that will cover all of these costs. How much coverage you have is one factor that determines how much you will have to pay in premiums. If you want to save money, you can agree to a lesser percentage of coverage and a greater co-payment amount.
Some dental insurance plans cover major dental procedures and some do not. These procedures include dentures, crowns, partials, dental implants, and surgical extractions. If you have a history of dental problems, it pays to get a plan that will provide you with at least 50% coverage for these procedures because they are usually the most expensive dental costs. Some insurers define root canals as a major procedure, so you should check the classifications before you buy.
When you purchase new dental insurance, don’t expect to get the full benefit right away. Most dental insurance plans will not allow you to use your major procedure coverage immediately. For example, you might have to wait as much as 12 months to have a crown or bridge covered by your new policy. This is how insurers guarantee that they will not lose money on your policy by paying for expensive procedures only to have you cancel the policy afterwards.
Additionally, most dental insurance plans have policies in place that prevent them from having to pay to replace missing teeth that you had prior to purchasing the plan. This is often referred to as the “missing tooth clause.” Similarly, most dental insurance plans will not pay to replace dental procedures immediately. Check the specifics of your plan to determine the length of the waiting periods and replacement periods.