If you’ve ever had questions about dental insurance, you’re not alone.

Today, we’ll break down what dental insurance is and services that generally are and aren’t included in dental plans. We’ll also discuss how our office staff can help you understand your coverage and payment options.

What is dental insurance?

Contrary to popular belief, dental insurance doesn’t function the same way as medical insurance. A better way to view it might be more like a cost savings plan or an allowance account. Dental insurance is meant to help prevent problems before they start and help cover the cost of some procedures if problems arise.  

With a dental insurance plan, you’ll still have the familiar things like copays, deductibles, and monthly premiums. The biggest difference? The annual maximum. 

With health insurance, your cost for treatments and procedures is typically covered once you reach your deductible. But dental insurance acts in the reverse — meaning you’ll have the costs of some treatments covered until you reach your maximum. 

The yearly maximum of dental insurance usually lands somewhere between $750-$2,000, with any cost incurred after that being paid out-of-pocket. 

Every dental plan is unique and specific in their definitions of what’s covered and what’s not. Let’s take a closer look!

What does dental insurance cover?

Now for the question you’re really here for — what treatments or procedures are covered by insurance? Dental coverage is usually grouped into 3 categories:

  • Preventive — exams, teeth cleanings, sealants (in most cases), x-rays, and more 
  • Basic — fillings, root canals, etc. 
  • Major — crowns, dental bridges, dentures, etc.

A good rule of thumb to keep in mind is that most plans operate under a 100/80/50 structure for coverage.

  • 100 percent of preventative treatments are covered
  • 80 percent of general treatments are covered
  • 50 percent of major treatments are covered 

What isn’t included in dental coverage?

Now you know what most dental plans cover — but what about what isn’t covered? This also varies from plan to plan, but uncovered dental treatments may include things like: 

  • Braces
  • Teeth bleaching or whitening 
  • Other cosmetic procedures 
  • Pre-existing conditions (such as missing teeth) 

Additionally, some other options, like x-rays and fluoride treatments, may be limited to a certain number of treatments per year or every few years. If you aren’t sure, it’s always a good idea to ask your dentist or your plan provider for more information. 

Why dental insurance doesn’t cover some procedures

It can be discouraging to find out a service you want isn’t included in your dental coverage. These treatments are often excluded because they’re either considered cosmetic procedures, or they fall under the “pre-existing condition” category. 

Cosmetic procedures, such as teeth whitening or gum reshaping, are services that improve the appearance of your teeth and may not be considered medically necessary for your health. 

Pre-existing conditions — a condition you had prior to enrolling in a dental insurance plan — are usually not included in coverage either, or they are tied up in a waiting period before treatment will be considered. Exclusion of pre-existing conditions is often referred to in the industry as the “missing tooth clause”. 

With that in mind, be sure to read the fine print — if the treatment isn’t covered now, it might be subject to a waiting period and available for coverage later. 

So should I get dental insurance?

All of this being said, you might be wondering if dental insurance is even worth it. The answer will vary from person to person. In some cases, dental insurance might not save you any money. 

For instance, say this year you only needed to go into the dentist for your annual exams, cleanings, and x-rays. That’s great! But you probably didn’t reach your insurance plan’s yearly maximum, because the cost of those exams doesn’t reach the full yearly maximum. 

On the other hand, say you go in for your annual exams and discover you need to get a crown or a couple of fillings — you will likely use most, if not all, of your yearly maximum. 

Whatever you decide, remember that your insurance coverage should never dictate your dental care.

Your dental health is worth it

It can be tempting to just skip a treatment if it’s not covered by dental insurance. But it’s very important to keep in mind that your overall health is directly tied to your oral health. In fact, poor dental health has been tied to conditions like:

  • Heart disease
  • Hypertension
  • Endocarditis
  • Pneumonia 
  • Alzheimer’s Disease

Besides regular brushing and flossing, and avoiding sugary and acidic foods, getting dental care when you need it is a huge step in making sure you and your smile stay healthy for a long time. Putting off your dental care not only makes the issue you are experiencing worse, but it typically means you’ll spend more later taking care of the problem. 

We’re here to help, whether you have dental insurance coverage or not 

Here at our Rogue Valley practice, our goal is to provide you with a healthy and long-lasting smile in the most caring way possible.

We never want you to be surprised by a bill from our office. We work closely with insurance companies and are proud to offer a number of benefits and payment options for our customers to ensure this doesn’t happen. These include: 

  • Consultations are available with our Financial Administrator before you set an appointment for treatment. They can tell you if your service will be covered by insurance and give you an estimate of what you can expect to see on your bill. 
  • CareCredit is a financing option that acts as a healthcare credit card. If your insurance doesn’t cover a treatment, CareCredit can apply towards out-of-pocket costs for a number of dental services. Many of our patients qualify for 0% interest financing through CareCredit.  
  • We offer many flexible payment options. You can even put money towards future treatments as you see fit! We accept cash, check, credit card, and offer a 5% discount when you pay in full at the time of your appointment. 

We’re here for you! Contact us with any questions or to set up your appointment.