Dental Insurance: What’s Covered, What’s Not Covered + Commonly Asked Questions About the Ins and Outs of Dental Insurance Coverage
You sit down at work and browse this week’s calendar. You’re scheduled to attend the annual open enrollment benefits meeting.
The optional benefits are always confusing. Without dental insurance, the out-of-pocket costs for unforeseen issues could be substantial. Is it worth the few extra dollars coming out of your paycheck?
Read further for a discussion on some great benefits of dental insurance, along with dental concerns that may not be covered.
Table of Contents
- A Brief History Of Dental Insurance
- Dental Insurance vs. Dental Benefits
- What Does Dental Insurance Not Cover?
- 4 Services Commonly Covered By Dental Insurance
- What Is the Most Dental Insurance Will Cover?
- Frequently Asked Questions About What Dental Insurance Covers
- Mint Dental Works Accepts Most Dental Plans for Patients in Portland, OR
A Brief History Of Dental Insurance
Dental insurance originated in 1954 and covered between $1000 – $1500 of dental needs — approximately the same amount that policies cover members today.
Dental policies can help lighten the burden of some of your family’s dental needs throughout the year, but you should not expect the policies to cover all your costs.
It’s important to understand what your dental policy covers when enrolling to avoid “surprises” regarding coverage.
Dental Insurance vs. Dental Benefits
Dental insurance is a policy (or plan) that covers or helps reduce the cost of dental procedures and oral health needs. Insurance policies may help cover unexpected dental needs related to emergencies, cavity care, fillings, or more extensive procedures such as root canals.
Dental benefits are the specific details of what that insurance plan covers, including the percentage of costs it will pay for different procedures, like cleanings, fillings, or crowns. Plans are geared toward maintaining consistent oral and overall health to avoid complications later in life.
Larger employers are more likely to offer dental insurance, but be sure to educate yourself on what specific dental care is covered.
What Does Dental Insurance Cover?
Dental care coverage largely depends on the insurance company and individual plan you or your employer have selected.
It is wise to consult the insurance company before completing any dental work — especially procedures that are not routine care.
4 Services Commonly Covered by Dental Insurance
- Preventative care
- Basic dental care
- Major treatments and services
- Orthodontic care
If you are seeking dental care in the SE Portland area, Mint Dental Works is equipped to handle your oral care needs and dental emergencies. You can trust the dental professionals at Mint Dental Works for comprehensive emergency and general dentistry services, with your well-being and comfort being our top priorities.
#1: Preventative Care
Preventive dental services are routine care practices that work to avoid dysfunction, oral health diseases, and complications later in life. These include prophylaxis cleanings (when there is no periodontal disease), exams every 6 months, x-rays, fluoride treatments, and sealants, all of which fall under preventive care. Many dental plans cover two cleanings annually, though some may offer more visits.
Depending on your plan, these services might be fully covered with no out-of-pocket costs. Even if you pay insurance premiums, it can be worth the investment if your routine care is covered each year.
#2: Basic Dental Care
Basic dental care may cover general concerns such as fillings, treating minor tooth damage without complications, or simple extractions. More advanced restorative and major oral care needs will likely incur a higher cost depending on your insurance plan.
Services are grouped into three classes for insurance purposes:
- Class A – Preventative
- Class B – Restorative
- Class C – Major
Both “Basic & Major Services” can be basic or major, depending on the plan. For example, Endodontics, Periodontics, and Oral Surgery may be listed as basic in one person’s plan but may be considered major in another’s.
#3: Major Treatments and Services
Of course, dental procedures can be much more complex than routine cleanings and X-rays. Our teeth work hard and sometimes require restorative treatment.
Thankfully, insurance may help cover a portion of the cost of procedures.
Examples of restorative care procedures may include:
- Impacted extraction
- Wisdom teeth extractions
- Dentures
- Bridges
- Implants
- Crowns
- Oral surgeries
- Gum grafts
- Root canals
#4: Orthodontic Care
Dentists offering orthodontic care focus on managing and correcting abnormal alignment of the teeth and jaws. They use tools like braces, Invisalign®, and retainers to help achieve these corrections.
Orthodontic care is not typically covered on individual dental plans. However, some employers offer group dental plans that may cover a portion of orthodontic care. In some cases, orthodontic coverage may only be an option for children 19 years or younger.
It is always important to check the coverage offered on your dental plan before dental work or procedures.
What Does Dental Insurance Not Cover?
Dental insurance and plans usually cover routine care and may assist with deferring the cost of more extensive procedures, but many plans typically do not cover cosmetic or elective procedures.
Examples of items and procedures that dental insurance does not typically cover include:
- Athletic mouth guards
- Night guard appliances to prevent damage from teeth grinding
- The use of nitrous oxide during a procedure
- Cosmetic dentistry such as veneers
- Teeth whitening
- Some pre-existing conditions that were present before plan coverage
- Out-of-network providers (some dental plans require you to see participating plan providers)
Common Misconceptions About What Dental Insurance Covers
It’s important to familiarize yourself with your benefits to avoid making the mistake of scheduling your routine exam and cleaning too soon.
Patients often assume their plan covers two exams and cleanings per calendar year or benefit year, and some do. However, some plans are written to cover one visit every 6 months. Essentially, this is two visits a year — but insurance will only pay if your visit is beyond six months of the previous visit.
Frequently Asked Questions About What Dental Insurance Covers
What’s the Difference Between In-Network vs. Out-of-Network Providers?
A provider network is a list of doctors, other healthcare providers, and hospitals an employer contracts with to provide medical care to its members.
Those on this list are network providers or “in-network providers.” Network providers offer benefits or services to the plan’s members at prices the provider and the plan agreed upon within a contract.
A provider that isn’t contracted with the plan is called an “out-of-network provider.”
What Is the Most Dental Insurance Will Cover?
While many plans will cover 100% of preventive care, there is a dollar range of annual maximum coverage a plan will allow.
The annual maximum coverage is usually between $1000 – $2000 per year and will renew each year. If the member exceeds the annual maximum allowance, the member will be responsible for covering the remainder of the charges.
How Do I Choose the Best Dental Coverage?
Consider your dental needs and stage in life as a starting point to choose the best dental coverage.
Do you have a young family that needs routine cleanings and exams to maintain their teeth? Or are you middle-aged with teeth that have seen some wear and tear and may need some procedures completed in the next few months?
Choose the dental plan that covers the services you anticipate needing.
Additionally, consider what you can afford in your monthly budget to cover premium costs. A comprehensive plan may offer the best coverage, but the premium may be higher than basic coverage plans.
Less coverage can save you dollars if you are in good health and anticipate only routine dental care.
What About Waiting Periods?
Sometimes as a new insurance member, you will be required to have a waiting period before you are allowed to utilize certain benefits. Waiting periods will vary plan-to-plan, and the waiting period often applies to the more advanced care only.
For example, you can usually schedule preventive services such as cleanings and exams. However, you may have to wait a few months before accessing more advanced dental work like fillings, extractions, crowns, bridges, and dentures.
Typical waiting periods for benefit usage include:
- Basic procedures – Three to six months
- Major dental work – Three months to one year
- More extensive procedures – Three months to one year or more
Mint Dental Works Can Bill Most Dental Plans for Patients in Portland, OR
Mint Dental Works is your SE Portland dentist. We strive to make a positive difference in the lives of our patients by offering excellent, customized, and comprehensive dental care in a comfortable and caring atmosphere.
Our professional team is committed to improving your health, appearance, self-confidence, and overall quality of life.
Mint Dental Works is in network with Delta Dental Premier and United Concordia Elite. We also welcome patients with out-of-network benefits or those without dental insurance.
Visit us for the latest dental treatment technology in a charming, affordable, and community-minded setting.
The content in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.