{"id":5268,"date":"2021-05-14T10:38:28","date_gmt":"2021-05-14T14:38:28","guid":{"rendered":"https:\/\/www.opencare.com\/blog\/?p=5268"},"modified":"2021-05-14T10:38:28","modified_gmt":"2021-05-14T14:38:28","slug":"what-dental-procedures-are-typically-covered-by-insurance","status":"publish","type":"post","link":"https:\/\/www.opencare.com\/blog\/what-dental-procedures-are-typically-covered-by-insurance\/","title":{"rendered":"What dental procedures are typically covered by insurance? Let’s break it down"},"content":{"rendered":"Reading Time: <\/span> 6<\/span> minutes<\/span><\/span>

In America and Canada, dental insurance coverage is quite pervasive. In fact, about <\/span>80% of Americans<\/span><\/a> have either private insurance (172 million) or enjoy publicly funded dental benefits (87.6 million).\u00a0<\/span><\/p>\n

But how many people actually understand how insurance works? Have you ever asked yourself \u201cwhat is covered by my dental insurance?\u201d Are you taking full advantage of your benefits to keep your pearly whites healthy? Read on to learn about how dental benefits work and what dental procedures are covered by insurance.\u00a0<\/span><\/p>\n

How does dental insurance usually work?<\/span><\/h2>\n

When you sign up for dental insurance, you\u2019ll pay a monthly premium, just like health insurance. Many plans also use a co-insurance structure. This means the insurance company will pay part of the cost of the procedure and you\u2019ll be responsible for the remaining amount.\u00a0<\/span><\/p>\n

For example, PPO plans (we\u2019ll explain more about this common type of dental plan later), use a 100\/80\/50 co-insurance structure. This means they\u2019ll pay 100% of preventative care costs, 80% of the cost of basic procedures (such as a dental filling), and 50% of major procedures.\u00a0<\/span><\/p>\n\t\t

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Many plans will have a deductible, which means you\u2019ll have to pay for a certain amount before your insurance kicks in. Annual maximums are also common, which means they will only pay up to a certain amount within a one-year period.\u00a0<\/span><\/p>\n

You can buy stand-alone dental insurance. However, many people have dental benefits attached to their medical insurance. A stand-alone plan tends to be more flexible and offers more benefits overall. They also are not likely to have a waiting period which means you can get the care you need faster.\u00a0<\/span><\/p>\n

Dental benefits as part of your medical plan are more convenient. However, there are typically more limitations on the benefits such as when and how they can be used.\u00a0<\/span><\/p>\n

Basic dental plans vs full coverage plans<\/span><\/h2>\n

Before deciding on a plan, it\u2019s important to be aware of what it covers. Dental insurance plans can be divided into two groups \u2013 basic and full coverage.\u00a0<\/span><\/p>\n

Basic dental plans cover preventative care costs. This includes coverage for routine dental visits, professional cleanings, and dental x-rays. Some plans will also offer partial coverage for basic procedures like fillings. However, your insurance co-pay will generally be higher.<\/span><\/p>\n

Full-coverage plans generally cover the same things as basic plans. You can expect preventative care coverage and basic procedures. However, they offer coverage for a wider range of procedures, as well as the percentage that is covered is higher.\u00a0<\/span><\/p>\n\n

With a full-coverage plan, procedures like crowns, root canals, and extractions may be covered. Plus, more advanced procedures like dentures, dental implants, braces, Invisalign, and other orthodontic procedures may also be included.\u00a0<\/span><\/p>\n

The name full-coverage is slightly misleading because they still won\u2019t cover 100% of your dental costs. Plus, each plan has its own list of covered treatments. Be sure to read the fine print carefully before undergoing dental treatment.\u00a0<\/span><\/p>\n

Types of coverage:\u00a0<\/span><\/h2>\n

Now let\u2019s talk about the various places you can get your insurance coverage.\u00a0<\/span><\/p>\n

Employer coverage<\/span><\/h3>\n

Most people with private insurance get it through their employer or some other kind of a group insurance plan. This is typically a less expensive way to get coverage, but not always so do your homework. It depends on the type of plan your employer offers.\u00a0<\/span><\/p>\n

Large employers are more likely to offer dental benefits, but some smaller companies also offer coverage.\u00a0<\/span><\/p>\n

Individual plans<\/span><\/h3>\n

If you don\u2019t have access to dental coverage through your employer, you can get an individual or family plan. Most preventative care costs will be 100% covered, however always read carefully to understand your whole coverage package.<\/span><\/p>\n

Medicare<\/span><\/h3>\n

The government program for patients 65 and over doesn\u2019t cover most dental care. There is one exception, however. Medicare Part A, which is hospital insurance, will cover certain dental services if the patient receives them while they are in the hospital.\u00a0<\/span><\/p>\n\n

VA benefits<\/span><\/h3>\n

Eligible individuals can buy discounted dental insurance <\/span>through the VA<\/span><\/a>. Coverage is offered through Delta Dental and MetLife. The patient is responsible for paying premiums as well as the full cost of copays.\u00a0<\/span><\/p>\n

Medicaid<\/span><\/h3>\n

Medicaid is another publicly-funded <\/span>source of dental benefits<\/span><\/a> used for people who can\u2019t afford dental care. Eligibility is based on income and coverage tends to be very limited.\u00a0<\/span><\/p>\n

All states are required to offer dental benefits to children, but each state can decide what they want to offer for adults. Most states offer at least emergency dental care coverage but fewer than half of the states offer comprehensive dental coverage for adults.\u00a0<\/span><\/p>\n

What procedures are typically covered?<\/span><\/h2>\n

Are dental cleanings covered by insurance? Preventative care is typically cheaper than dealing with the ravages of periodontal disease or other dental issues. To that end, most dental plans offer coverage for the following:<\/span><\/p>\n