What Does Your Dental Insurance Plan Cover?

Do you know what your dental insurance plan covers? If not, don’t worry – most people don’t truly understand their coverage. However, dental insurance is notably different from medical insurance, so it’s important to inform yourself and get to know the details of your plan. Luckily, we’ve put together a guide to help you out. Although benefit plans vary from person to person, here’s a basic outline of what the average dental insurance plan covers.

First, let’s take a look at the most common types of dental insurance plans you have to choose from:

1. Preferred Provider Organizations (PPO) – With this plan, you have more flexibility when picking a doctor or hospital. These plans feature a network of providers and have fewer restrictions on seeing non-network providers. However, choosing an out-of-network provider will likely result in higher out-of-pocket costs.
2. Dental Health Maintenance Organization (HMO) – This plan gives you access to certain doctors and hospitals within its network. Unlike PPO plans, you won’t be able to receive coverage when seeing an out-of-network provider.
3. Dental Discount or Dental Savings Plan – These plans allow members to choose from a select group of participating dentists who charge discounted fees for their services. Unfortunately, none of your care will be covered – you’ll simply be charged a discounted rate.

Although every dental insurance plan is unique, most follow a 100-80-50 structure for coverage. In most cases, here’s what you can expect to be covered:

1. Preventive Care – Services like checkups, cleanings, oral cancer screenings, and routine X-rays are usually 90-100% covered.
2. Standard Treatments – Fillings and treatment for gum disease are also covered but at a slightly less percentage of 70-80%.
3. Major Procedures – More complex services like root canals, dental crowns, and extractions are typically only covered at 45-50%.

Did you know that plenty of Americans leave almost $1,000 worth of dental benefits unused by the end of their coverage period? Don’t let that be you! Follow these tips to help you maximize your benefits:

1. Understand your plan. Review the details of your plan document to help you understand what’s covered. If you need help decoding the language, call your benefits office and someone will assist you.
2. Keep up with preventive care. Most dental insurance plans allow two cleanings and checkups for little to no out-of-pocket cost. Make sure you attend all your routine visits!
3. Schedule restorative treatment as soon as possible. If you need restorative treatment, schedule your appointment right away before your condition worsens. Otherwise, you may need a more complex procedure and those are usually the ones with the least amount of coverage.
4. Remember your benefits have a deadline. Most benefit plans end on December 31st, meaning any unused benefits will expire – and they typically don’t roll over into the new year. Utilize them before you lose them!

Hopefully, this guide helped you better understand what your dental insurance plan covers. Now that you know more about your plan, you can take the steps necessary to keep your oral health in its best shape!

About the Practice

At Weber Family Dentistry, we strive to provide truly personalized, compassionate, exceptional dental care that’s bound to exceed even your highest expectations. Our team wants you to feel at ease every time you visit our dental office. If you have any questions about your dental insurance plan, we’re more than happy to answer them for you. Visit our website or call (402) 417-0642 to reach a member of our team.