For individuals comparing dental insurance policies, thinking of changing plans, or looking for an affordable option like a discount dental program, it helps to know exactly what falls under the “benefits umbrella” before you make the monetary investment. For most dental insurance policies, the following types of services are covered in some varying degree:
Before any type of dental treatment can be rendered, a proper diagnosis must be made. Your insurance policy will cover a variety of different screening procedures, such as:
A comprehensive oral evaluation (new patient exam)
- Periodic oral examination
- Emergency exams
- Bitewing, periapical, FMX, or panoramic x-rays
- Oral cancer screenings/testing
Once a baseline exam and diagnosis is recorded, your oral health conditions are monitored between checkups, to determine if any advancements of disease become evident. As such, diagnostic steps are a vital part of reducing the overall cost of your dental care.
Preventive services are meant to help you avoid conditions like cavities and gum disease. They include prophylactic dental cleanings and gum disease screenings with the dental hygienist, protective dental sealants to block decay from deep grooves in your teeth, and fluoride treatments to remineralize weak enamel. Most insurance policies will cover two preventive care appointments per year, or one visit every six months.
Of all procedures covered under dental insurance, diagnostic and preventive services are usually reimbursed at the highest level. They are vitally important in promoting oral health and reducing the need for additional intervention caused by a lapse in prophylactic care.
Restorative Treatments and Therapeutic Services
Fillings, dental crowns, gum disease treatments, root canals, and the like all fall into one general category: fixing/repairing disease conditions to restore your oral health back to a disease-free state. Depending on how evolved the disease condition is, your dental insurance policy will reimburse the procedure at different levels. The more evolved (and longer care has been delayed,) the more likely you are to pay a larger amount of money out of pocket for the treatment.
Having a straight smile can reduce the risk of TMJ disorder, headaches, tooth wear, cavities, and gum disease. It even limits how likely a person is to have a dental emergency (jetted out front teeth are especially likely to become fractured.) Most dental insurance plans pay for braces, regardless of whether they are traditional brackets and wires or clear, removable aligners.
More extensive dental treatments such as oral surgery, surgical tooth extractions, wisdom teeth removal, or oral cancer treatments often require trips to a specialty clinic or hospital. These services generally call for an overlap in coverage between your dental and medical plans.
Exclusions, Limits, Etc.
Your dentist should provide you with a basic breakdown of treatment fees and estimated insurance benefits so that you know about how much of the total cost will come out of your own pocket. Even then, these fees are estimated, as your insurer may adjust whether or not they pay for something after the service has already been rendered.
Generally speaking, even though something may be “covered by dental insurance,” there may still be limitations or exclusions to keep in mind. Here are a few examples of when your treatment might not be reimbursable under your dental plan:
- Cosmetic, elective treatments that serve an aesthetic purpose only
- Age restrictions on procedures like braces, sealants, or fluoride
- Deductibles required up front before a treatment can be claimed/processed
- Your maximum allowable (the dollar amount where your benefits are exhausted for the year)
- Clauses such as pre-existing dental conditions, that may disqualify certain procedures
- How often certain types of “covered” procedures can be performed. Such as a full mouth x-ray series every 3-5 years, or only two cleanings per year
- If a pre-approval is required before the treatment can start
- Waiting periods prior to starting specific types of treatment
Looking for a better way to save on your dental care? If you don’t have benefits through your employer, consider private enrollment in your own dental insurance or indemnity plan, or enrolling in a dental discount plan through Cal Dental Plans. Enrollees save anywhere between 10-60% on routine dental services like fillings, braces, and more. Contact us today to learn more!