Dental Insurance – What Is Covered?


Dental insurance, sometimes also known as a dental savings plan, is essentially a type of medical insurance designed to cover a portion of your dental expenses. Dental insurance pays a portion of dental costs in exchange for a monthly fee paid by you. The monthly fee can vary, based on the plan. It may be good value for your money if you have dental insurance but it’s probably not worth your time to look into if you don’t already have dental insurance.

A few types of dental insurance, you might consider are Cost Per Action (CPA), Preferred Provider Organization (PPO), and Scheduled Dental Plans (SDIP). Cost Per Action, otherwise known as CPA, covers preventive dental services only. PPO and SDIP cover both major and minor dental procedures. With these plans, you pay for the procedure once and then you’re covered for the rest of your life. There are different cost sharing formulas for each plan and it’s best to discuss them with a qualified professional before purchasing. When it comes to cost for dental insurance plans, the most important part is the waiting period. Most plans have an out-of-pocket waiting period before the policy kicks in and starts paying for the procedure. Here, your out-of-pocket costs are deferred until you clear the waiting period.

Generally speaking, the more comprehensive your insurance plan, the less out-of-pocket costs you will have to incur. Full coverage plans typically cover all dental procedures and oral surgeries, so you will be fully covered up to a certain amount for procedures such as braces, extractions, root canals, and other in-clinic treatments. The amount you’ll be covered for depends on your insurance provider. Your provider may require you to visit an in-network dentist or pay higher co-pays and deductibles in order to gain full coverage. Out-of-network providers can offer you more benefits, so it’s often a good idea to shop around and compare costs and benefits.

If you don’t want any out-of-network providers because of lower costs, or if you already have one dentist you regularly see, your best bet is to purchase an individual dental insurance policy. Individual insurance policies typically provide coverage for routine cleanings and specific procedures like crowns and root canals. With these services, you will only need to visit a participating dentist, and will be required to pay the agreed upon co-pay and deductible.

In addition to routine cleanings, checkups, and certain procedures like braces and extractions may be covered with an individual dental insurance policy. If your provider doesn’t offer full coverage, it’s a good idea to inquire about payments plans and other payment options. Some plans may even allow you to make partial payments over time, so your payments won’t be as stressful if you need them right away. Be sure to find out the maximum limit you’ll need so you won’t be held financially responsible for much more than you need. Keep in mind that many insurance companies will not cover cosmetic procedures like Botox and rhinoplasty. If they do, your provider may require you to undergo a waiting period or may require you to use anesthesia during the procedure.

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