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What does dental insurance cover?

By: | Tags: | Comments: 0 | September 22nd, 2017

If you’re wondering what your dental insurance covers, you’re not alone. We get a lot of patients who avoid certain types of procedures because they think these treatments aren’t covered by insurance. Here at Audubon Dental Center we believe in patient education, providing resources to our patients that will help them along in their personal oral health journeys.

Considering that good oral health is showing itself to be linked to good overall health, we thought it would be a good idea to go over dental insurance, as well as the types of procedures that are generally covered (and not covered) by many insurance providers.

So, if you pay for dental insurance privately, or get it through your place of employment, you may as well be using it. Here are some general procedures that are covered by most health insurance providers.

80% to 100% Covered Treatments Include:

• Regular Check Ups
• Cleanings
• Fluoride Treatments
• Dental Sealants
• X-rays

Treatments with 70% to 80% coverage generally include more critical work (also considered “basic care”), like:

• Root Canals
• Fillings
• Tooth extractions

Major care is often covered at 50%, including:

• Permanent dental bridge work
• Full and partial dentures
• Periodontal (gum) care
• Crowns

Finding insurance providers that cover braces can be a challenge. Providers rarely cover orthodontia (various forms of braces) because, in most cases, orthodontics often are considered an aesthetic procedure and do not often prove “medically necessary.” But if orthodontia is deemed necessary after an accident or when the patient has intense malocclusion (for instance, brought on by cleft palate), insurance providers are more likely to cover a portion of the expense. Check with your provider to see if they cover a portion of adult or your child’s braces.

Your provider may pay some (or in some cases all) fo the bill for the following procedures:

• Dental emergencies, including trauma and injury
• Cleft malocclusion
• Certain types of oral and maxillofacial surgery
• Wisdom tooth extraction

It is rare for insurance providers to cover things like:

• Dental Implants
• Porcelain veneers

Insurance plans are generally designed for routine maintenance, basic care, and emergencies. Plans will always pay for lowest cost treatment options. In the case of dental implants, partials or dentures would be the treatment they’d pay for.

Things to Consider

Make sure that you know what your cap is. Most plans have a cap between $1,000 and $2,000, which is the maximum payout they offer annually. Keeping in mind that a crown can cost around $800, and a standard oral exam might run you around $100, know that your funds can dry out quickly.

We hope this helps. Audubon Dental Center accepts a variety of insurance carriers (view the list of insurers we accept), most PPO’s under the sun. Contact us today to schedule your consultation. Your oral and overall health depends on it.

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