How much does Dental Insurance cover?
Dental insurance is a great benefit for many employees. It can help you pay for expensive care that you would otherwise be forced to do without or pay for out-of-pocket. There are many different dental insurance plans, but most cover certain standards costs.
Basic Dental Care
Almost every dental plan provides basic dental care, which is usually defined as two professional cleanings per year for each covered member of your family and bite-wing x-rays once a year for each person. Some plans do not cover x-rays unless the dentist certifies that they are needed for diagnostic reasons, while some plans allow them as part of the regular course of basic treatment.
Dental cleanings include scaling for tartar buildup, polishing with a fluoride toothpaste, flossing, and an examination by your dentist to check for cavities or gum disease. It is very important for you to have your cleanings twice a year to prevent cavities and other problems. In fact, this coverage is usually referred to as “preventative” care.
You may be required to pay a co-pay for preventative care, but most plans cover 100 percent of cleanings. You will need to schedule your cleanings for six months apart, as most plans will not cover these cleanings if you schedule them too frequently. Your dentist’s office can help you determine your insurance company’s policy about scheduling regular preventative care.
Basic Covered Procedures
Dental plans vary greatly in how much they pay for basic covered procedures such as fillings or root canals. Some dental plans pay 80 or 90 percent of these procedures, but most pay about 50 percent. Some plans also have a deductible that must be met before any coverage is offered for these procedures.
For example, a typical dental plan might have a $500 deductible for each covered member up to $1500 for a family. If you have a family of five covered members, three of them would have to meet the deductible before you satisfy this requirement. If you required a tooth filling that cost $150, you would have to pay the full amount out-of-pocket; you would then have $350 left to pay on your deductible. If you required five such filings in a year, your insurance would cover the last $250 of the $750 total cost; at that point, the insurance company would pay 50 percent, or $125, of that $250 amount.
If you have options for dental coverage, you should consider how much the deductible and co-pays are on each plan so that you can choose the best coverage for your situation. If you have a large family and use the dentist frequently for fillings and other dental work, you can choose a plan with a family deductible and a low co-pay. On the other hand, if you are single and rarely have a filling, it might be better to choose preventative care only and pay for fillings out-of-pocket.
Other Covered Procedures
Dental plans vary widely in the procedures they cover outside of routine fillings and other basic procedures. Some plans offer orthodontic care while some do not; for many plans this is an option that you must choose when you sign up for the coverage. If you have children and if you already know that they will probably need braces, you want to consider orthodontic option plans which often pay at least half of the cost of this care. If, however, you are single and do not need orthodontic work, it does not make sense to pay more for this coverage.
Many plans pay at least 50 percent for crowns if the work is needed to treat a diseased tooth and to prevent further decay. However, the same rules will probably apply as for fillings; you will often have to meet a deductible and then pay half the remaining cost to have a root canal and crown. Wisdom tooth removal is also usually covered by dental plans if the wisdom teeth are impacted and it is necessary to extract them.
Cosmetic Dental Care
Very few plans pay for cosmetic dental work. This is considered an optional treatment by most insurance providers and usually they will pay nothing for this type of care. Cosmetic dental work includes teeth whitening, overlays, and dental caps. However, many plans will pay for cosmetic dental work if you need it as the result of an accident or disease. In other words, if you break a tooth and must have it capped, this is not considered optional cosmetic work; however, if you simply decide to have your teeth capped because you want a whiter smile, most plans will not pay for this.
There are cosmetic dental plans available, but they are very expensive and often do not cover much in the way of dental care. It is often better to finance this type of dental work with a low-cost loan or medical financing plan, especially if the plan offers no-interest payments for a certain amount of time. Many dentists have become members of networks that offer no-interest financing for non-covered dental work to encourage patients to choose this kind of care. Financing plans usually require you to have a good credit rating and to provide income verification. However, most people can qualify for financing, so this is a viable option if you choose to have non-required cosmetic dentistry performed. Be sure to examine the financing terms carefully so that you understand your obligations for payments and how much you will ultimately pay in interest.
You should carefully read the terms of coverage for any dental insurance plan before making a purchase. Whether it’s insurance under your employers group or an independent dental plan make sure to purchase coverage that will cover what you need.