What Services Are Covered?

Dental insurance helps reduce your out-of-pocket expenses by paying for a portion of the cost associated with covered services.  But only some services may be covered in full.  Others will be partially covered, and some won’t be covered at all.  Evaluate your current and future needs to determine what services you will use.  Make sure the plan you choose covers those services.  Be sure you don’t select a plan with coverage that is too limited.  Just because you’ve never had a cavity doesn’t mean you won’t develop one.

In general, there are four types of services that are covered when purchasing dental insurance—basic, comprehensive, major and orthodontics.  Basic services include routine treatments necessary to maintain a healthy smile such as exams, x-rays, cleanings and more.  Comprehensive services are more extensive than basic treatment.  Examples include root canals, denture treatment/repair and more.  Major services include the most involved treatment you can receive such as bridges, crowns and possibly more.  Many insurers have a waiting period for major services.  Orthodontic treatment includes therapies like braces that are necessary for straightening teeth.  These plans usually have a waiting period as well.

Are There Any Exclusions?

In addition to finding out what services are covered, it’s important to learn what is not covered when purchasing dental insurance.  Some plans exclude certain services.  If you need treatment that is not covered under your plan you will be responsible for the full cost of the service.

Is There a Waiting Period?

Some plans have waiting periods before you are eligible to receive coverage for certain services.  If you select a plan with a waiting period, you must wait the required amount of time before your insurance carrier will cover the cost of those services.  If you need treatment before the waiting period is up, you must pay for the treatment out of your own pocket.

How Much Does it Cost?

There are many costs associated with purchasing dental insurance.  The most common is the premium or the amount you must pay each month to maintain coverage.  But there are others you need to factor into your budget as well, including deductibles and copayments/coinsurance. A deductible is the amount you must pay before the insurance carrier will begin paying for covered services.  A copayment or coinsurance is the portion of the bill you are responsible for after you have met your deductible.

In addition to these fixed costs, you may also be responsible for any expenses incurred over the plan maximum.  Dental insurance plans do not pay an unlimited amount for your dental care.  When purchasing dental insurance, each plan has an annual maximum amount the carrier will pay toward services rendered.  If you exceed this amount, you are responsible for covering the cost of additional treatment you receive.