If you want to save as much money as possible on your dental care, then understanding how dental insurance works is crucial. However, trying to figure out what is and isn’t covered under your policy can sometimes be confusing, which could cause you to miss out on your benefits. Luckily, your dentist in Houston is here to help! Here is a basic outline of the coverage most dental insurance plans provide.
How Dental Insurance Coverage Works
Your insurance company will pay a specific percentage for treatments that are included under your plan, leaving you to pay the rest out of pocket. The exact amount your insurance company pays depends on what policy you have as well as the kind of service being provided. Most insurance plans provide coverage according to the 100-80-50 structure, which means:
- 100% coverage for preventive care like checkups, cleanings, fluoride treatments, and X-rays.
- 80% coverage for basic restorative care like dental fillings.
- 50% coverage for major restorative care like crowns, dentures, and bridges.
You likely noticed that under this structure, preventive services receive more coverage than restorative services. This is because dental insurance is not like regular medical insurance; while it does help pay for care in the event of an emergency, its main focus is on encouraging patients to avoid oral health problems altogether so that they can avoid more costly treatments.
It’s worth noting that certain services are classified differently depending on what plan you have. For example, root canal therapy is most commonly considered a basic dental procedure, but some insurance companies treat them as a major procedure. That’s why it’s always worth double-checking with your insurance company before you begin any sort of dental treatment.
What Isn’t Included Under Dental Insurance?
Dental insurance is meant to help you pay for treatments that improve or restore oral health. For this reason, cosmetic treatments are normally not included; they’re strictly elective procedures that only enhance the appearance of the smile and usually don’t have any notable health benefits. That said, every plan is different, and some will pay for cosmetic treatments under certain conditions.
Also, while there are dental insurance plans that pay for implants, many companies consider them a cosmetic treatment and won’t provide coverage. However, they might still pay for part of the final restoration, and they will often cover preliminary procedures that are meant to prepare the mouth and jaw for implant surgery.
If you have any questions about your dental plan, don’t forget that you can always turn to your dental team. They work with a wide range of plans every day, so they’ll be more than able to explain your coverage and help you find the best way to fit your upcoming treatments into your budget.
About the Author
Dr. Gregory Palmer earned his dental doctorate at Tufts University School of Dental Medicine. He is a Texas native who is proud to be able to provide high-quality dental care to his friends and neighbors. His practice, Palmer Dental Group of Houston, accepts a variety of insurance plans and is in-network with common providers like MetLife and Cigna. To schedule an appointment with Dr. Palmer, visit his website or call (713) 221-7398.