What Sort of Coverage Is Provided by My Dental Insurance Plan?

Did you know that your smile is one of the first features that people will notice about you? Your pearly whites aren’t just for eating—they’re also your pride and joy, so you should take steps to ensure their healthy and beauty. One of the best ways you can do this is by having dental insurance; however, when it comes to insurance plans, there are often several confusing details and stipulations that are difficult to make sense of! Here’s some insight from your dentist in Love Field about what types of plans are normally available and what they usually cover, so that you can set up your smile for lasting beauty and wellness.

What Types of Dental Insurance Plans are Available?

There are a few different kinds of dental insurance plans, and the three main types include:

• Preferred Provider Organization (PPO) – PPO plans are quite common, and if you’re enrolled in one, you have the option to visit a dentist either inside or outside of your insurance provider’s network. However, sticking to an in-network practice often means you’ll have lower out-of-pocket costs.
• Dental Health Maintenance Organization (DHMO) – These plans function a little differently than PPO plans. They require you to visit a dentist that your provider has approved, and if you try to seek care outside of this approved list, you might not be covered.
• Discount dental plans – These programs provide you with a pre-negotiated rate for certain services that you can expect to pay if you receive dental care from a select group of practices. Although none of your services are technically covered, you’ll still receive a nice discount on the services rendered.

What’s Covered by My Dental Insurance?

Of course, there are several differences between these types of plans, primarily concerning what’s covered by them. In addition to knowing how your individual plan works, it’s worth knowing which procedures and treatments are typically fully or partially covered, as well as what isn’t covered at all. Here’s a brief breakdown of the 100-80-50 coverage structure that’s utilized by most plans:

• 100% coverage – Fortunately, preventive dental care is often fully covered by most dental insurance plans—insurance companies and dentists alike understand the value of these routine visits! Regular checkups and cleanings are inexpensive, but also instrumental in preventing serious and costly oral health issues from progressing. These visits also include oral examinations, X-rays, plaque/tartar removal, and more.
• 80% coverage – Minor restorative care and similar treatments are usually covered by up to 80% after your plan’s deductible. Even though some plans interpret “minor restorative care” differently, services covered often include things like fillings, simple tooth extractions, and other noninvasive procedures.
• 50% coverage – Major services like oral surgeries, tooth restorations such as crowns and implants, root canal therapy, and more are typically only covered by up to 50% of the plan’s deductible. Sometimes these total costs can easily exceed a plan’s maximum, meaning that it’s sometimes wise to schedule treatment for the following year as well—this allows you to take advantage of two different deductibles, assuming your coverage doesn’t lapse.

It’s also worth nothing that more often than not, cosmetic and elective procedures aren’t typically covered at all by insurance—though it never hurts to check the specifics of your plan!

Dental insurance can be confusing and raise many questions; but it isn’t something that should deter you from seeking treatment, especially considering that it helps you bear the financial burden. That said, understanding how your coverage operates and knowing how to fully maximize your benefits will allow you preserve your smile’s beauty and integrity for many years to come—and in an affordable manner!

About the Practice

The team at Bear Creek Family Dentistry has proudly catered to the dental needs of the Love Field area and surrounding DFW metroplex for several years. They’re pleased to offer a wide range of services including preventive, cosmetic, restorative options and more. If you have any questions about how to fully maximize your dental insurance coverage or would like to arrange a visit, feel free to visit the practice’s website to find a location near you.