Dental Insurance Overview
Why Have Dental Insurance?
Discount or Referral Plans
Traditional and Indemnity Insurance
Capitation Dental Plans (DHMO's)
What Does My Plan Cover?
Preferred and Exclusive Providers
Get the Most out of Your Insurance
Choosing a Plan
Where Can I get Insurance?
 

What Does My Plan Cover?

Know Your Coverage

No matter what type of insurance you choose, you will want to read the fine print. Making sure you are covered for what you think you are, or for what your family needs is very important. Paying for insurance that does not meet your needs is ridiculous. And insurance coverage and policies differ from plan to plan, even within the same company.

Basic Coverage

There are certain things that every policy should cover. Most insurance policies run on a 100/80/50 system. Preventive care is covered at 100%, minimal corrective care is covered at 80% and major treatments often at 50% of the fee.

Here are the basics your plan should offer:

Preventive Care (usually at 100%)

  • Initial examination by the dentist – once per dentist
  • Regular office exam or check-up – twice yearly
  • Complete set of dental x-rays – approximately every three years
  • Bite Wing X-rays – these check for cavities – once a year
  • Teeth Cleaning – twice a year (be careful here some policies say specifically every 6 months)
  • Topical Fluoride Treatments – twice yearly
  • Sealants – for children under 18

Corrective Care (usually covered 70% - 80%)

  • Restorative Care – basic fillings and simple crowns
  • Endodontics – root canals
  • Oral Surgery – basic tooth removal, minor surgery needed for things like removing infection
  • Periodontics – minor care for gum problems
  • Prosthodontics – repair of dentures or bridges – replacing linings, etc Major Care (can be covered from 50%- 80% but usually less than 80%)
  • Restorative – gold crowns or individual tooth crowns
  • Oral Surgery – complex – impacted teeth, etc
  • Periodontics – complicated gum diseases, bone care etc
  • Orthodontics – retainers, braces,
  • Dental Implants
  • Prosthodontics – dentures, bridges, partial bridges

Insurance companies will not normally pay for new or experimental procedures. Some treatments require pre-approval and may be limited by the plan you choose.

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