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The Basics of Dental Insurance Coverage

October 17, 2020

Filed under: Uncategorized — wemakeyousmile @ 6:57 pm
Dental insurance form on desk next to glasses

As the end of the year approaches, your 2020 PPO dental insurance may be on the verge of expiring. Before that happens, you should certainly consider how you can use your plan to your greatest advantage! To help you do that, we are providing a basic overview of how your policy might apply to various services. Keep in mind that every dental plan is different, so you will have to check the specifics of your coverage to discover the best way to use it.

Preventive Care

Dental insurance companies love preventive care. If you are diligent about attending checkups and cleanings, your insurer is likely to avoid having to help you out with major restorative care down the road. That is why most policies allow you to attend two preventive appointments each year while paying little to nothing out of pocket. Some services that are generally covered include:

  • Routine cleanings
  • Necessary X-rays (some plans cover just one set of X-rays each year)
  • Exams

Restorative Care

If your dentist discovers a cavity during your checkup and informs you that you need a filling, your insurance will probably cover 70% – 80% of the cost of your treatment. That is because fillings typically fall under the umbrella of what insurance companies deem to be “minor restorative care.” Simple extractions are also usually designated as minor restorative care.

For more extensive treatments, which are considered “major restorative care,” your insurance will probably only pay about 40% or 50% of the cost, up to the amount of your annual maximum. (Your maximum is the greatest amount that your insurer will pay out for approved services during your coverage period.) Crowns and bridges usually fall into this category.

Root canal therapy and scaling and root planing are a few examples of services that might be designated as either minor or major restorative care.

Other Services

Here are some points on how your insurance might apply to specialty services:

  • Dental implants: Some insurance companies offer coverage for implants, while others do not. If yours does not, it still might help you pay for your implants’ restorations.
  • Cosmetic dentistry: With very few exceptions, dental insurance plans do not cover cosmetic care. However, if a treatment will both improve your smile’s appearance and is necessary for your oral health, it is more likely to be covered.
  • Orthodontics: Coverage for orthodontics varies widely between dental insurance policies. Some of them offer once in a lifetime assistance with Invisalign or traditional braces.

Hopefully, this quick guide has given you some insight into your how dental insurance works. Your local dental team will be happy to further assist you in understanding and using your coverage the next time you book an appointment.

About the Author

Dr. George A. Hoop is the leader of the team at Total Dental Solutions for Adults. He has more than 30 years of experience in his field. As an insurance-friendly dentist, he is happy to accept payment from most PPO dental insurance plans. To learn how our team can help you use your coverage to your greatest advantage, contact us at 239-939-7299.

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