What Does Your Dental Insurance Plan Cover?

About 77% percent of Americans have some form of dental insurance, according to the National Association of Dental Plans. However, many people sign up for dental insurance without fully understanding how it works. As a result, they end up either not getting the care they need or paying too much for it. To make the most of the benefits you’re paying for, it’s important to learn a few basics. Let’s break down the answer to the question “what does your dental insurance plan cover?”

Key Dental Insurance Terms

If you’re not familiar with many of the “technical” words your insurance company throws around, it can certainly feel overwhelming! Here are a few common terms you should know to better understand your policy:

• Deductible: The amount you must spend out-of-pocket before your insurance company begins paying for your care.
• Annual maximum: The highest amount of money your insurance will pay toward your care in a given period, typically a calendar year.
• Premium: The amount you pay the insurance company every month in order to qualify for coverage.

The 100-80-50 Rule

Every dental insurance policy differs, but most of them follow the same 100-80-50 guideline in terms of which services are covered. Your plan will generally look something like this:

• Preventive and diagnostic services, like checkups, cleanings, and x-rays, are generally covered at 80-100%.
• Basic treatments, including gum disease therapy and fillings, are typically covered at 70-80%.
• Major procedures, such as root canal therapy and dental crowns, are often only covered at 50%.

Depending on the details of your plan, different services will fall under different categories and qualify for different amounts of coverage. You’ll need to review the details of your policy or discuss it with your dental team to fully understand your benefits.

The Importance of Making the Most of Your Dental Insurance

Research shows that the vast majority of Americans with dental insurance leave almost $1,000 worth of benefits unused at the end of their coverage period. In most cases, any leftover benefits do not roll over into the next year. If you don’t use all of the coverage in your annual maximum, you’re essentially paying your premiums for no reason!

To maximize your benefits, make sure to schedule two checkups and cleanings a year. Also, get any additional dental work you may need (like fillings or crowns) taken care of before the year ends. What’s more, regular preventive care can save you money down the road. Your dentist can catch early signs of oral health problems before they become pricier issues.

These basics should be enough to help you mostly understand your dental insurance. For any further questions, your dentist and their team should be more than happy to help!

About the Author

Dr. Sujal Patel practiced dentistry in his home country of India before moving to the United States and earning his Doctor of Dental Surgery degree from New York University. His Dallas practice, Coco Dental Center, is in-network with many, many popular dental insurance plans, including Aetna, Cigna, Delta Dental, and Humana. To learn more about how to save money by making the most of your dental insurance, contact Dr. Patel’s office at 972-629-9339.