What Does Your Dental Insurance Plan Cover?

Between work, taking care of the family, and trying to squeeze in time to see friends, you probably don’t spend much thought on your dental insurance. Could you confidently say what your dental insurance plan covers? Understanding the basics of how your insurance plan works can help you get the most out of your monthly investment. Keep reading to learn about how most dental insurance plans function as well as some helpful tips to maximize your coverage before the end of the year.

The 100-80-50 Coverage Model

While every plan is slightly different, most dental insurance providers follow the “100-80-50” coverage model. This framework covers some portion of preventive services, restorative procedures, and major treatments, usually as follows:

• 100% of Preventive Care – Routine dental exams, cleanings, and fluoride treatment.
• 80% of Basic Procedures – Dental fillings, simple extractions, and root canals.
• 50% of Major Procedures – Crowns, bridges, and dentures. 

Pro tip: when it comes to preventive care, most dental insurance plans cover two routine checkups per year. If it’s been more than six months since you last saw your dentist, don’t hesitate to schedule your next dental exam and cleaning. It likely won’t cost you a penny!

What Does Dental Insurance Not Cover?

Do you notice anything missing from the “100-80-50” model described above? Cosmetic dentistry! Most dental insurance plans do not cover teeth whitening, veneers, cosmetic bonding, and other aesthetic treatments. While cosmetic dentistry can dramatically improve the appearance of your smile, it’s usually not considered “medically necessary” by insurance providers.

Fortunately, there are other ways to reduce the out-of-pocket costs of cosmetic dentistry. For example, many dental offices offer flexible financing with little-to-no interest through CareCredit. 

Use It or Lose It!

Another thing to keep in mind is that your dental insurance benefits likely do NOT roll over into next year. If you have already met your deductible but have not exceeded your annual maximum, you still have benefits left. Whether they’re worth $50 or $500, any unused benefits will disappear at midnight on December 31. Better use it or lose it!

Dental Insurance Changes

Finally, keep in mind that many dental insurance plans change on an annual basis. Premiums, deductibles, and benefits are often adjusted at the beginning of the year. So, if you like your current dental insurance plan, do not wait until next year to take advantage of your benefits! Your coverage could look significantly different in a few months.

Like any investment, you should want to get a good return on your dental insurance. Talk to your dentist for more tips on maximizing your dental insurance benefits.  

About the Author

Dr. George Stoddard has over 25 years of experience working in the dental world. The proud University of Texas graduate offers in-network benefits for most local insurers, including United Healthcare, MetLife, Humana, Aetna, and more. To learn more ways to take full advantage of your dental insurance, visit the Longview Dental Center website or call 903-753-9758.