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Important Dental Procedures: What Does Dental Insurance Cover?

January 23, 2019

Does your insurance cover the most important dental procedures? Check out this guide to the common procedures covered by dental insurance

Many people are curious about what dental insurance covers. For many Americans, dental insurance is not worth it and they choose to pay out of pocket.

More than a quarter of Americans do not have dental insurance. Also, more than half of Americans forgo preventative and intermediate dental care due to cost.

However, this is a costly mistake over the long-term. Skipping cleanings and fillings is certain to lead to major services like root canals. Dental insurance is the solution to high costs, not the problem.

Read on for the answers to what does dental insurance cover. Learn more about what dental procedures are covered by dental insurance.

Preventative Care

Preventative care is the key to keeping dental costs down. For this reason, insurance companies offer generous coverage for preventative care.

This usually takes the form of annual or biannual cleanings and evaluations. The cleanings are referred to as prophylaxis and are critical to fighting tooth decay and gum disease. Also, the dentist takes x-rays to see if there are any issues under the surface.

Intermediate Care

This is the next step in the dental care process after initial diagnosis. Perhaps the dentist uncovers a cavity or a chipped tooth during the evaluation.

Intermediate care includes dental procedures like bondings and fillings. In general, insurance companies cover fewer expenses for intermediate care than preventative work.

The concept behind dental insurance coverage is called coinsurance. This is a cost-sharing mechanism between the insured person and the insurance company.

Coinsurance is something to take into consideration when shopping for plans. For example, a plan may require 40 percent coinsurance for intermediate dental procedures. This means that the insured person is responsible for 40 percent of the bill.

The insured person also greatly benefits from the negotiated rate between the insurance company and dental provider. Without insurance, the insured person is responsible for the full amount charged by the provider.

Insurance companies negotiate significantly better rates, which then get passed down to the insured person.

Major Care

In some severe cases, major dental procedures are needed. Examples of these procedures include root canals, crowns, and oral surgery.

It is common for your coinsurance percentage to rise for major dental procedures. For instance, you may be on the hook for 60 percent of the bill now.

Orthodontic Work

Some dental plans offer orthodontic coverage. If so, this means you receive coverage for items like braces and retainers.

Orthodontic work is usually subject to coinsurance as well. Your coinsurance responsibility is likely to lie somewhere in between intermediate and major care.

Other Items to Consider

While shopping for plans, you also want to consider the deductible level. If you have a deductible, coinsurance will not kick into until you reach the deductible level in out-of-pocket expenses.

Another thing to weigh is the annual maximum benefit. Some plans set a maximum benefit level. If this level is reached, insurance coverage will cease for the remainder of the calendar year.

A Recap of What Does Dental Insurance Cover

Intermediate and major dental procedures carry a large price tag. Carrying dental insurance yields a positive return on investment if you need this type of work done.

In addition, keeping up with preventative care reduces the likelihood of needing a major procedure. If you want to learn more about what does dental insurance cover, please contact us to discuss it further.