What Do Most Dental Insurance Plans Cover?

What Do Most Dental Insurance Plans Cover?

People can choose from a few different types of private dental plans, each covering different treatments, procedures, and providers to varying percentages with additional out-of-pocket costs. However, there are some basic services that most dental insurance plans cover. Keep reading to learn more about what’s covered and what’s not.   

What Do Most Dental Insurance Plans Cover?

While there isn’t a defined classification in the industry that specifies which services fall under the categories of basic, major, and preventive, most dental insurance plans cover a combination. When comparing plans, it’s essential to compare each carrier’s definition of preventative, basic, and primary services and what portion of each is covered under their policies.  

Most dental insurance plans typically cover a portion of the costs for routine preventive care, basic services, and some dental surgeries. The following lists are examples of the types of services that usually fall under each of these categories.  

Preventative care generally covers:

  • Dental X-Rays
  • Teeth Cleanings
  • Dental Exams
  • Dental Sealants

Basic dental care generally covers:

  • Tooth Extractions
  • Fillings

Major dental procedures generally cover:

  • Root canals
  • Dental crowns
  • Dental bridges
  • Dental implants

Individual Policies

Individual policies typically come with waiting periods. Due to this reason, periodontics, prosthodontics, and other major treatments and services may not be available for up to the first year of coverage. It’s also worth noting that orthodontics usually requires a rider, for which members are required to pay an additional fee regardless of their policy type.

100-80-50 Structure

Many dental insurance plans follow a 100-80-50 structure for coverage. What this means is that preventive care services are covered at 100%, basic procedures are covered at 80%, and major procedures are covered at 50% or a higher co-payment. However, a carrier may also avoid covering some treatments and procedures (such as sealants, for example).

Annual Maximum Caps

All dental insurance plans have an annual maximum cap, which means there’s a limit to how much the insurance carrier will pay during a member’s plan year. Many companies set this cap on the lower end, and you must pay any expenses exceeding that amount. 

For example, suppose the annual maximum is $1,500 or less; you need a root canal that costs $1,600. In that case, you’ll have reached your yearly maximum and have to pay the additional $100 plus the total cost of any treatments or procedures for the remainder of the year following the treatment. 

On the other hand, some insurance plans may exclude some services and treatments to lower their costs. You should be sure to know what specific services the plan you’re considering covers and which it excludes.