What Can My Dental Insurance Cover?

What Can My Dental Insurance Cover?


Your dental insurance is there to help you keep your family’s smiles healthy and provide some financial relief when unexpected oral health needs pop up. Contrary to what most people think, dental insurance policies aren’t there to cover 100% of every procedure that your dentist performs.

But, here’s what they can cover, at least partially:

Checkups, Cleanings, and Preventive Care

By nature, dental problems are best treated by being completely avoided. Your dental insurance policy will likely cover almost 100% of your preventive cleanings, exams, x-rays and similar procedures. Services like fluoride or dental sealants are usually covered up to about 14 years of age. When you take advantage of all the preventive care services that your dentist has to offer, you can avoid unwanted (and costly) treatments down the road.

Orthodontic Treatment

If you or your child has crooked teeth, it can set you up for a higher chance of cavities, headaches, gum disease, or even TMJ disorder. Most insurance plans include a limited range of benefits on orthodontic therapy (including clear or removable braces.)

Oral Surgery

Biopsies, frenectomies, and wisdom tooth removals impact everything from your quality of life to your overall health. While insurance may cover a portion of these services, you can help to keep your costs low by seeing your family dentist when possible (as opposed to automatically asking for a referral to see a specialist.)

Treating Gum Disease

Periodontal disease is no laughing matter. Approximately 90% of adults have some form of gum disease, and when left untreated, it results in tooth loss. If you are skipping your “free” dental cleanings, your insurance is going to scale back how much they cover for gum disease treatments (like deep cleanings.)

Dental Emergencies

Most emergency dental visits will include an exam and x-ray, usually at little to no expense upon your part. If any treatment is performed to get you out of pain, such as a tooth extraction, you will need to be prepared to cover a portion of the service on the day that you receive it.

Repairing Broken and Decayed Teeth

When it comes to restoring and repairing your teeth, dental insurance splits into two levels of coverage: basic and major. A filling would be basic, so your insurance policy would cover more of it (such as 80%) while a crown would be major and they would cover less of it (such as 50%.)

This is important, as it is an incentive to you as the policy purchaser to have your dental problems treated when they are smaller and more affordable. Delaying your care costs more for everyone.

Replacing Missing Teeth

After a tooth has been pulled, you’ll need to replace it as soon as possible. Otherwise, the other teeth can start to shift and alter your bite. While conventional dental insurance didn’t cover dental implants a few years ago, more policies are changing their stance on this. Other options that may be covered as major work include bridges or dentures.

A Note About Aesthetic and Cosmetic Dental Procedures

Unfortunately, cosmetic treatment isn’t ever covered by dental insurance. This would include “smile makeover” appointments like veneers, aesthetic bonding, or teeth whitening. The only time when this isn’t the case, is when a restorative treatment like porcelain crowns or bonding is providing a both a protective and cosmetic service at the same time (such as if the upper front teeth are severely broken/decayed.)

Get an Estimate from Your Dentist

Working with an in-network dentist will save you money when it comes to paying for what your dental insurance doesn’t cover. The best way to find out exactly how much money you will be out of pocket is to provide all your policy information to the financial coordinator, and get a breakdown of your estimated benefits. While this is an educated estimate, it is still only an estimate. Things like waiting periods or missing tooth clauses could prevent you from getting the most out of your insurance policy.

If you’re considering changing dental insurance plans or finding coverage that’s more affordable, you may want to consider a discount dental plan. Dental discount plans provide different tiers of discounts across the board, even on services like cosmetic dentistry or braces without any hidden fees or clauses. Plus, the plan can be accepted by any participating dentist. For more information, contact one of our dental savings experts.

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