What Should a Dental Plan Cover?

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The right dental plan can provide you with peace of mind at an affordable price. So, as you shop for dental insurance, it’s important to be aware of what your options are, and how those options vary in terms of what they cover and what they don’t.

Preventive Care

Generally, you can expect that dental coverage plans will help you meet the costs of preventive care, which is so important when it comes to maintaining the health of your teeth and gums. After all, when you see your dentist regularly, he or she can find problems in their earliest stages, when they’re easiest, and most affordable, to treat.

Keep in mind that dental plans (even within the same carrier) don't consistently have the same procedures and services listed under the categories of preventive, basic, and major. Therefore, it’s important to check plan details carefully to confirm the categories that specific procedures fall under. 

When it comes to preventive care, what might be covered?

     • Dental exams

     • Dental cleanings (typically recommended twice a year, but some insurance providers will cover more than two cleanings annually)

     • X-rays


Most plans will take care of 100% of the cost of preventive care, which means you won’t have to sacrifice seeing your dentist for those important checkups. But, again, review plan details closely to be absolutely sure. 

Basic Dental Procedures

A great dental insurance policy will also cover basic procedures, which are more expensive than preventive care trips to the dentist.

What treatments fall under this category?

     • Fillings

     • Extractions

     • Periodontal (gum) treatments 

     • Root canals

Oftentimes, anywhere from 70% to 80% of the costs of these procedures will be taken care of by your insurance provider. So you may need to cover some of the cost, but it will still be much more affordable than if you didn’t have any insurance at all.

Major Dental Procedures

Major procedures are the priciest, so having the right dental insurance policy can help you rest assured you won’t break the bank to get your oral health back on track.

What are some of the major procedures that are typically covered?

     • Crowns

     • Bridges 

     • Implants 

     • Dentures 

     • Implants

Your dental policy might cover around 50% or less of the cost of a major procedure. But, again, even this amount of coverage is really helpful, especially since these procedures can be expensive.

Note: Different insurance providers might categorize basic and major procedures differently. As an example, you might come across one provider who lists root canals as a basic procedure, while another provider considers it a major procedure. For this reason, it’s wise to carefully read through the fine print of a dental plan before signing on the dotted line. 

Orthodontic Care

When it comes to orthodontics, there are plans that include some level of coverage for this category of care. Other plans might only provide coverage if you purchase a rider that adds extra benefits to your policy.  What orthodontic services might be covered by dental insurance?

     • Orthodontic dental exams 

     • Pre-orthodontic treatment 

     • Fixed and removable appliances, such as braces and retainers 

     • Post-orthodontic treatment

Note: Some dental plans might only include coverage for orthodontic care for children, while others will extend that coverage to adults as well.

Cosmetic and Restorative Dental Procedures

Usually, even full coverage dental plans won’t cover the cost of cosmetic dental procedures, such as whitening treatments. However, if a cosmetic procedure is deemed a medically necessary restorative treatment, dental insurance might kick in and help cover the cost.

If you need a restorative treatment because of dental disease, tooth decay, tooth loss, or tooth damage that results from an injury or an accident, your insurance plan might help. If you want to undergo a procedure merely to make your teeth look better, that would be considered cosmetic and, more than likely, would not be covered by insurance. Again, different plans will offer different amounts of coverage for these types of procedures.

The Main Types of Dental Insurance

There are a few types of dental insurance plans that you can look into. Each has its own set of pros and cons to consider as you shop.

The main types of dental plans are briefly described below:

     • Dental Health Maintenance Organization: Also referred to as DHMO, these plans typically have lower premiums, but you will  need to stick with using one of the dentists that are in network.

     • Dental Preferred Provider Organization: Also known as a DPPO, this plan might provide greater amounts of coverage compared to a DHMO, and you have the option of seeing an out-of-network dentist but your out-of-pocket costs will be higher if you do.

     • Dental Indemnity Insurance: This plan gives you the most freedom to choose your dentist, along with a lower deductible. It will cover a percentage of the cost of care, but the premiums are usually higher than other options.

Shop Smart and Find the Dental Plan That’s Right for You

There are a lot of things to consider as you shop for high coverage dental plans. But with an understanding of what’s covered and what isn’t covered by the majority of dental insurance providers, you can shop smarter after determining what level of coverage you need.With so many plans available to suit individuals, families with children, and seniors, it’s best to take your time and read through what each one has to offer. That way, you can find the ideal plan that will match your expectations and budget.

Using a service like the Direct Benefits Marketplace can make the process of shopping for dental insurance a breeze, as you can quickly and easily compare various providers and plans to see what they cover, what your out-of-pocket costs will be, and more.