If you’re shopping around for dental insurance, you’ll have plenty of insurance companies and policies to choose from. And although each policy is likely to differ in some ways, there are usually some similarities when it comes to what a typical dental insurance policy will cover and what it won’t. What follows is a summary of dental services that are usually covered by insurance, as well as those that are not.
Dental Services Typically Covered by Insurance
- Cleanings and exams: The majority of dental insurance policies cover 100% of routine diagnostic and preventive services. Of course there is a limit to that coverage. Most policies cover two visits per patient, per year.
- Fillings, extractions and root canals: Dental insurance usually covers 80% of these types of basic dental procedures.
- Crowns, implants and bridges: Restorative procedures are typically covered by dental insurance policies, but only to a limited extent. Most will only cover 50% of these services.
Keep in mind that you may have to meet a deductible before your insurance will cover a portion of the costs for fillings, extractions, root canals, and restorative services. Fortunately, a deductible doesn’t usually apply for cleanings and exams.
Dental Services Typically Not Covered by Insurance
- Cosmetic services: Unfortunately, most cosmetic dental procedures are not covered by insurance. These include services such as teeth whitening, dental veneers, dental bonding and sealants, for example.
- Orthodontics: Many dental policies won’t cover orthodontic services, such as braces or clear plastic aligners used to straighten teeth. However, some insurance companies will provide partial coverage, so you should ask your agent or insurance company representative.
- Pre-existing conditions: Although there are exceptions to this rule, generally speaking, the majority of dental insurance policies won’t provide coverage for pre-existing conditions.
This means if you had an oral health issue prior to signing up for your insurance policy – such as missing teeth, for example – you’ll have to pay 100% of the costs involved in treating that condition.
There are other considerations that may impact how your dental policy provides coverage benefits. For example, your policy may involve a waiting period before you become eligible to receive benefits. And virtually all policies will impose an annual maximum amount that the insurance will pay during a 12-month period, so any expenses incurred past that annual maximum will be out-of-pocket.
Keep in mind that every policy is different. So if you have questions or need further clarification about what your dental policy will and will not cover, be sure to ask the insurance company or your insurance agent.
