What Does Your Dental Insurance Cover?

Dental insurance benefits usually expire at the end of the calendar year. When December rolls around, you may be wondering how you can get the most out of your plan before it resets on January 1. To learn more, check out this basic guide on what a typical dental plan covers. It will help you know what to expect the next time you visit your dentist in Palm Bay to get the most out of your dental insurance!

Preventive Care

Preventive care is the foundation of a healthy mouth. Dental insurance plans recognize this, so they usually cover two checkups and cleanings each year at 100 percent. That means you can enjoy a clean and fresh mouth for nothing out of pocket! In many cases, preventive care is even exempt from a plan’s deductible.

Minor Restorative Care

Often, minor restorative care is covered at 70-80 percent, after you take care of your plan’s deductible. Insurance plans can vary in what they define as “minor” services, but this category often includes fillings and simple extractions, as well as nonsurgical gum disease therapy. In some cases, root canal therapy is also included.

Major Restorative Care

Major services are usually covered at 40-50 percent, up to the amount of a plan’s annual maximum. (An annual maximum is the highest dollar amount that an insurance company will pay out for services within a calendar year.) Often, the cost of a major procedure will exceed a plan’s maximum. To reduce your out-of-pocket expenses, you may choose to schedule part of your treatment in 2022 and the rest in 2023, so you can use two annual maximums.

Most oral surgeries, such as wisdom tooth extractions, are usually considered to be major services. Crowns, bridges, and dentures also typically fall into this category. Root canal therapy may be considered a major treatment as well.

What Isn’t Covered?

Dental insurance plans commonly exclude purely cosmetic services, such as teeth whitening, veneers, and other procedures which have the main purpose of enhancing the look of the teeth. Orthodontia is also excluded from many plans. Dental implants may be another service that is not covered; however, more and more plans are beginning to include them as a major restorative procedure.

If you would like any procedure that your dental insurance does not cover, talk to your dental team about other payment options, such as financing or an in-house discount plan. No two dental insurance plans are exactly alike. However, armed with the above information, you are now in a better position to understand your coverage and use it to your greatest advantage!

About the Author

Dr. Christopher Nowacki has been working hard for the smiles of patients since earning his dental doctorate in 2004. He’s a member of the American Dental Association and the Academy of General Dentistry. If you have further questions about your dental insurance plan or any of Dr. Nowacki’s services, you can call (321) 724-9300 or schedule a consultation on his website.