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What Does Your Dental Insurance Plan Cover?

September 19, 2020

Filed under: Uncategorized — drcaballeros @ 3:53 pm
woman pondering what her dental insurance plan covers

About 77 percent of Americans have dental insurance to some degree, according to the National Association of Dental Plans. However, because dental insurance is quite different from medical insurance, many people aren’t quite sure how it works or what types of services are covered. In order to make the most of your benefits, it helps to know a few basics. Keep reading below to learn about some important terms you need to know, as well as what services are typically covered.

Dental Insurance Terms to Know

To understand how dental insurance works, it’s crucial to learn a few key terms. Here are some common insurance terms you should know:

  • Deductible: The amount you must pay out-of-pocket before the insurance company begins paying for your care. For dental insurance, this number is quite low, usually around $50.
  • Annual maximum: The highest dollar amount your insurance company will pay for your care in a given period, typically a calendar year. For most plans, this is between $1,000 and $1,250.
  • Premium: The amount you pay every month you pay every month in order to qualify for coverage.
  • Copay: The leftover amount you must pay out-of-pocket after your insurance company has paid for a portion of your treatment.

Of course, copays vary from service to service. It all depends on how much coverage your insurance carrier is willing to give you.

The 100-80-50 Rule

While each individual dental insurance policy differs, most of them follow a 100-80-50 guideline when it comes to determining which services they cover. Here’s what that means:

  • Preventive and diagnostic care, such as checkups, cleanings, x-rays, and oral cancer screenings, are usually covered at 80% to 100%.
  • Basic procedures, such as fillings and gum disease treatment, are often covered at a slightly lower percentage of 70% to 80%.
  • Major procedures, such as dental crowns and bridges, are typically only covered up to 50%.

The need for more extensive procedures like fillings or crowns can be largely avoided by attending regular checkups and cleanings. That’s why dental insurance normally covers the full cost of these preventive visits.

The Importance of Using Your Benefits Before the Year Ends

Most Americans only use about $323 of dental care every year, leaving almost $1,000 worth of benefits unused. For most plans, any benefits that have not been used at the year’s end do not roll over into the next year. That means you’re essentially paying your premiums for nothing!

To get the most out of your insurance, schedule a second checkup before the end of the year. You could also get any needed dental work, such as a crown, taken care of. Not only will this ensure your yearly maximum isn’t wasted, but routine checkups can prevent smaller oral health issues from spiraling into larger problems. This can benefit your smile and your wallet!

Once you know the basics, dental insurance isn’t hard to understand. Don’t hesitate to ask your dentist if you have any further questions.

About the Practice

At On Point Dentistry, we have not one, but two expert dentists. Dr. Marco Caballeros has earned a Fellowship with the Academy of General Dentistry, and Dr. Carlos Parra has lectured nationally and internationally in the field of periodontics (dentistry specializing in the care of the gums). We happily accept most major dental insurance plans. To learn how you can maximize your benefits, visit our website.  

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