What Does Dental Insurance Cover? [Ultimate Guide]

What Does Dental Insurance Cover? [Ultimate Guide]

More than 3 out of every 4 Americans have a dental insurance policy. But what most do not understand is that it can be a life savior if you choose the right coverage and a money wastage if you don’t. Thus, it is essential to know what does dental insurance covers? An informed decision can result in good care and savings both simultaneously— A win-win situation!


Dental Insurance- An Overview

Dental insurance helps you maintain good oral health at a fraction of the cost. Most companies emphasize preventative and diagnostic care. They provide 100% coverage for such procedures as exams and cleanings, etc. But this differs from policy to policy. So, check it with your agent.


What Does Dental Insurance Cover?

The services provided by dental insurance are divided into three categories:

  1. Preventative Care
  2. Basic Services
  3. Major Services


#1: Preventative Care

A few preventive and diagnostic services under dental insurance include:

  1. Dental Exams
  2. Routine Teeth Cleaning
  3. Dental X-Rays (usually done annually)
  4. Fluoride Treatment (in-office)
  5. Tooth Sealants


#2: Basic Services

A few necessary procedures that you can get on discounted prices due to insurance are:

  1. Cavity Fillings
  2. Emergency X-Rays
  3. Emergency Dental Care
  4. Tooth Extraction


#3: Major Services

Some more advanced and complicated procedures that you can avail of dental insurance are:

  1. Root Canal Treatment
  2. Scaling and Root Planing
  3. Dental Crowns
  4. Dental Inlays and Outlays
  5. Dental Bridges
  6. Dentures
  7. Dental Restoration Repairs
  8. Oral Surgery
  9. Dental Anesthesia

Do remember that insurance companies do not pay 100% cost of treatment. Some may pay 100% for the preventive care but not for other services. Also, a deductible applies to availing of these services.

Also read: Difference Between Critical Illness Insurance and Health Insurance

Dental insurance companies usually have a 100-80-50 rule.

According to this rule, they cover preventive care at its 100% cost. And the basic services at 80% cost and major services at 50% cost.


Does Dental Insurance Cover Crowns?

Yes and no. It depends on why you are taking the procedure. If you are getting the procedure done because of cosmetic purposes, the insurance might not cover you. However, if you want to get it done due to medical reasons, dental insurance will protect you.

But do remember that the insurance usually covers only 50% of the cost. Generally speaking, the crowns’ cost ranges between $807 to $2,015, and the median lies at $1,500. Plus, the deductible also applies to the treatment.


Does Dental Insurance Cover Dentures?

Dental insurance does cover dentures. But, there are a few ifs and buts associated with it. The first issue is that the company pays only 50% of the cost. Secondly, deductible and copays add to the treatment separately. Thirdly, dentures’ treatment cost starts from $2,500, and the annual maximum coverage gap is usually $1,500. Thus, a lot of people find themselves paying a lot from their pocket. So, the treatment costs can be substantial.

Also read: 5 Major Insurance Policies Everyone Should Have!

And for this very reason, dental discount plans come into the picture. These discount plans offer a few listed services at a discounted price. And it has been seen that you can get a better deal with these discount plans in many cases than the insurance.


Does Dental Insurance Cover Teeth Whitening?

Dental insurance does not cover cosmetic procedures like teeth whitening. Simply because teeth whitening and other procedures like veneers, etc., are aimed at improving the look rather than medically necessary.

A teeth whitening procedure may cost you anything between $450 to $600. The actual price can differ depending on the office pricing and location. Since insurance does not cover these procedures; thus, some dentists offer discount plans for such cosmetic treatments

Some services that are called cosmetic procedures and are not covered by insurance are:

  1. Teeth whitening
  2. Tooth shaping
  3. Veneers
  4. Gum Contouring, etc.


What Is Not Covered Under Dental Insurance?

Nothing is perfect, and dental insurance is no exception. Like everything, there are gaps in dental insurance too. So, here are three conditions when dental insurance will not cover you.

  1. Most plans do not cover expensive procedures like Orthodontia. But it differs from plan to plan.
  2. Teeth whitening and other cosmetic procedures are also not covered in the insurance.
  3. Lastly, let’s say you have some pre-existing conditions, like a missing tooth at the time of buying insurance. Then you will have to pay for that out of your pocket. The insurance company will not pay for it.


Are There Any Other Limitations?

Sadly, there are. Here are a few more restrictions that you must be vary of before entering into a contract. If you are aware of these limitations, you can end up with a better policy.


#1: Waiting Period

The waiting period is the amount of time, say a few months, before you can avail of any service. For example, before you can get dentures, you may have to wait a year or two. For availing of any basic service, the waiting period can be anywhere between 3 to 6 months. It is kind of a norm in individual policies, but some employer-sponsored policies may have it too.


#2: Other Restrictions

Many miscellaneous restrictions are also there. Like you can only have a full X-ray once every five years. Or there can be a set time limit between two filling sessions. These restrictions differ from policy to policy. So either clarify this from your agent or read the fine print properly.


#3: Annual Maximum

The last limitation is the annual maximum cap. Annual maximum means an upper limit after which the insurance people will not pay for your care. You have to pay from your pocket. For example, let’s assume your annual maximum is $1,500. So, if you have already spent $1,500 on dental care, anything after this will come from your pocket.

Also read: 9 Factors to help you choose the best Disability Insurance?

However, it is improbable that you will have to pay from your pocket.

So, this was all in our guide about what does dental insurance covers. But if you have any doubts, please drop them below in the comments section. We will reply ASAP.