October 25, 2021

What Does Dental Insurance Cover?

Dr. Chilcoat @ 1:35 pm
Dental insurance paperwork on clipboard in Dallas

You know your dental insurance is important, but do you know how it works? Recent surveys indicate that thousands of dollars’ worth of unused dental benefits go to waste every year. If you don’t know what your dental insurance covers, then it can be nearly impossible to maximize the benefits you’re paying for! Read on as we go over some important basics about what you can expect from your dental insurance coverage.

The 100-80-50 Rule

Every dental insurance policy is different, but most follow a similar pattern of coverage. Generally, the idea is that the more invasive a procedure is, the less coverage it receives. Here are some examples:

  • Preventive care, like checkups, diagnostics, and screenings, often get 90-100% coverage.
  • Basic treatments, such a gum disease therapy or fillings, may receive between 70-80% coverage.
  • Major procedures, including dental crowns and root canals, are typically awarded 50% coverage or less.
  • Cosmetic services, like teeth whitening or veneers, typically don’t receive any dental insurance coverage.

Deductibles & Maximums

Before your insurance begins paying for your treatments with the 100-80-50 rule, you may need to meet something called a deductible first. This is how much of your own care you need to pay for before your benefits kick in. Once you meet your deductible, your insurance company will pay for your treatments up until a set dollar amount, known as the maximum. Neither of these amounts roll over to the next year, so if you’ve met your deductible but not your maximum, you still have benefits you can use until the end of the year. However, if you have a HMO, you may not have a deductible or a maximum to worry about.

What Your Insurance Doesn’t Cover

Your coverage will also depend on what type of dental insurance plan you have, HMO or PPO. Here are some of the main differences in coverage outside of the 100-80-50 rule:

  • In or out of network: To receive coverage with an HMO, you need to visit one of the dentists “in-network” with your insurance. For PPO patients, you can see out-of-network dentists for slightly less coverage.
  • Premiums: The monthly fee you need to pay to keep your insurance coverage active. Typically, PPOs have higher premiums than HMOs.
  • Copays: This is the amount you need to pay your dentist when you visit them for an appointment. HMOs have copays, while not all PPOs have copays.

Understanding exactly what your dental insurance does and does not cover will help you save money and keep your smile healthy. If you have questions about your coverage, call your provider or speak with your dentist’s team for assistance.

About the Practice

Our team here at Texas Wisdom Teeth strives to make every part of dental care and surgery in Dallas as pleasant as possible, from consultation to treatment to payment. That’s why we are in-network with numerous popular dental insurance companies as well as Medicaid. For our uninsured patients or those displeased with their coverage, we also offer financing options through CareCredit and special offers on some of our treatments. To learn more about how to make your dental care as affordable as possible, visit us online or give us a call at (972) 960-1111.

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