What Does Your Dental Insurance Plan Cover?

Dental insurance can be complicated. There are a lot of details and stipulations to pay attention to, and every plan is a little different from the next. How can you navigate your benefits and use them to your greatest advantage without feeling too overwhelmed? You can start by familiarizing yourself with what your plan does and does not cover. Here is an overview of how most PPO dental plans work:

Preventive Care

It is standard for dental insurance to cover 100% of the cost of preventive care, including two exams and cleanings each year, as well as routine X-rays. Some plans also include fluoride treatments in this category. Often, a policy’s deductible is waived for preventive services, so you might not have to pay anything out of pocket.

Also, note that while 100% coverage is common for preventive care, you may have to pay a small percentage of the price of your services if you visit an out-of-network dentist (a dentist who does not have a contract with your insurance company).

Minor Restorative Services

Minor services usually include fillings and simple extractions. Some insurance companies also include root canal therapy in this category. Usually, minor services are 80% covered after you pay your deductible, which is often around $50. If you visit an out-of-network dentist, your coverage rate might be around 70%.

Major Services

Major dental services usually include crowns, dentures, and some types of oral surgery. In some cases, dental implants are also included. Often, major services are 50% covered, up to the amount of a plan’s annual maximum. (An annual maximum is the highest dollar amount that an insurance company will pay for approved services within a calendar year.)

What Is Not Covered?

Dental insurance plans do not always provide coverage for:

• Orthodontia. Some plans have a specific clause that includes a lifetime maximum for braces and clear aligners. Others do not cover orthodontia at all.
• Cosmetic services. Veneers, teeth whitening, and other services that are considered to be purely cosmetic are almost never covered by insurance.

Getting to Know Your Insurance Plan

Every dental insurance plan is a bit different from the next, so you should take time to familiarize yourself with the details of your unique policy. You can do so by reviewing any documentation that came with your plan and keeping tabs on things like waiting periods, deductibles, copays, and other restrictions or considerations.. If you have questions, you can contact your insurance company or chat with a dentist who accepts your insurance. They will be able to help you figure out the details of how your benefits work and how you can use them to your greatest advantage.

Meet the Practice

Cline Family Dentistry of Idaho Falls is a family practice that is proud to help patients in our community enjoy top-quality care at reasonable prices. We welcome insurance, and we are in-network with several well-known companies, including Delta Dental, BlueCross BlueShield, and more. To find out how you may be able to use your benefits in our office, contact our team at 208-487-5987.