Covered vs. Not Covered: What You Should Know About Dental Insurance

When learning you need a root canal, you are not only overcome by the reality of having to undergo this type of procedure, but you begin to wonder if you’re even covered by your dental insurance for such treatment. Will they step in to ensure your expenses are lowered, or will you be required to pay out of pocket, resulting in your saving quickly dwindling? A dentist explains the basics surrounding dental insurance and what you can expect to be covered versus services that will require you to seek alternative ways to pay.

The Breakdown of Coverage Levels

When enrolling in a dental insurance plan, your main focus is likely to be how much you can expect to pay each month for access to your benefits. This is what is known as your premium – what you agree to pay your insurance company in return for their help when services are rendered. But as you scan the details of your policy, the information may become a bit muddled, as confusing terms may keep you from feeling inspired to learn more.

What you really need to know and understand, however, is that most plans follow a similar pattern when it comes to the percentage of coverage an insurer provides. This is commonly known as the 100-80-50 design, which means:

• 100% of preventive services are typically covered (i.e., dental exams, cleanings, X-rays, fluoride treatment)
• 80% of basic restorative services are covered (i.e., dental fillings)
• 50% of major restorative services are covered (i.e., dental bridges, crowns, tooth extractions)

Once you meet your deductible, your insurance company will agree to pay more for the services you receive. However, it is important to remember that your annual maximum is also considered by your insurer, as the more funds that are used, the less they will agree to pay.

The Truth About Cosmetic Dentistry

While general cleanings, dental crowns, tooth extractions, fillings, and even root canals tend to be covered by dental insurance, one group of services is not – cosmetic dentistry. Viewed as elective procedures that are not necessary for the improvement of your oral health, veneers, teeth whitening, direct bonding, and other similar procedures will need to be paid for using alternative solutions. This can include cash, check, or credit card, or you can opt for flexible financing through a third party like CareCredit.

If your dream is to transform your smile with customized veneers, you may want to rethink your decision before diving into treatment, especially if cost is a factor. But if you’re ready to use your dental insurance to keep your teeth and gum healthy year-round, get ready to save big each time you visit the dentist’s office.

About the Author
Dr. William Twohig is a skilled dental professional who believes in high-quality care and affordable services. As a holistic dentist in Weyauwega, he encourages patients to pursue preventive care, as it is the most effective way to minimize oral health problems in the future. To better understand the details of your plan, visit our website or call (534) 429-5965. Our dental team will be happy to answer any questions you might have as you prepare for your upcoming appointment.