Dental Health Info Article

What Does Dental Insurance Cover

Red, swollen and bleeding gums are often a sign of gum disease.

When deciding what sort of dental insurance to get, it’s vitally important that you know what procedures you’re receiving coverage for. It is a frustrating experience to show up for a treatment and give your dentist your insurance details, only to find out a few months later that you’re on the hook for medical expenses worth thousands, simply because you didn’t check your coverage beforehand! Let’s explore what’s covered by each type of dental insurance, as well as what you can’t receive coverage for, so you’ve got the full picture before deciding on your dental plan.

What Does PPO Cover?

A PPO is a type of dental insurance plan which gives you access to an entire network of dentists in your local area at a reduced rate. You can choose to go outside of the network if you want, but your rates will go up. The typical PPO covers:

  • Preventative procedures. This helps you to catch problems before they become serious. They include x-rays (periapical, bitewing, and full-mouth), cleaning, sealants, fluoride treatments, and basic examinations.
  • Basic procedures. These are simple procedures which don’t require the dentist to incur very many laboratory expenses. They include emergency dental care, fillings, extractions, root canals, gum disease treatment, periodontal scaling, and non-routine x-rays.
  • Major procedures. These are complex procedures which require laboratory expenses. They include dental crowns, bridgework, implants, dentures, orthodontic treatment, inlays, onlays, anesthesia, and complex oral surgery procedures.

Most PPO plans have what’s known as 100-80-50 coverage. This means that the plan pays for 100% of your routine preventative and diagnostic care, 80% of your basic procedures such as root canals and fillings, and 50% of your major procedures such as bridges and crowns. But remember, unless the cost of your procedure meets your deductible, your PPO plan won’t cover any of your bills.   

What Does DHMO Cover?

A DHMO, Dental HMO, restricts your dental insurance coverage to a relatively small network. DHMOs tend to cover the same procedures as PPOs, the only thing that differs is the rates that you pay for each treatment. In a DHMO, the rates are usually lower, and you’ll rarely have to pay anything for preventative or diagnostic treatments such as x-rays and basic examinations. In addition, DHMOs tend to charge lower co-payments (the amount you pay for each service) than PPOs.

What Does an Indemnity Plan Cover?

An indemnity plan (also known as a traditional dental plan) allows you to visit any dentist in the world. You’ll have to pay the full cost of your treatment up front, and then submit a claim to your insurance provider. They’ll pay a percentage of the cost, and you pay the rest. Typically, the procedures that you can receive coverage for are the same as PPOs and DHMOs.

What Isn’t Covered by Dental Insurance?

Just as important as what is covered by dental insurance is what isn’t covered:

  • Cosmetic. From teeth whitening and veneers to gum contouring, cosmetic dental services are almost never included on dental insurance plans.
  • Braces. Although some plans do cover braces, you’ll usually have to pay a rider (an add-on to a basic policy which provides you with extra coverage, for an extra cost), or the braces treatment will have a separate lifetime maximum limit. For many adolescents, braces are a necessity, making this non-inclusion particularly challenging for families. If you do need to pay for braces, you could opt to pay with a healthcare credit card as an alternative.
  • Pre-existing conditions. It’s possible that your dental insurance plan won’t cover conditions that you had prior to taking out the policy.
  • Missing teeth. Although you won’t be barred from receiving dental insurance coverage if you’ve got missing teeth, you may find that your coverage is restricted. In this instance, it’s probably worth shopping around for the very best deal.

Now that you know what sort of dental insurance coverage you can expect to receive from the various types of dental insurance plans, you can choose a plan that really works for you.

Need help finding a Dentist with the right dental insurance plan for you? Call 1-800-DENTIST today to see how we can help!