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What Sort of Coverage Does My Dental Insurance Provide?

September 6, 2022

Filed under: Uncategorized — willowgrovedentist @ 6:05 pm
Patient filling out dental insurance forms.

Your smile is one of the first things that people notice about you—so you should take steps to ensure that your pearly whites are as healthy and bright as possible! One of the best ways you can do this is by having dental insurance. But when it comes to insurance plans, there are usually a lot of confusing details and scenarios that are difficult to sift through. Here’s some insight into 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 types of popular dental insurance plans. The three main ones include:

  • Preferred Provider Organization (PPO) – PPO plans are quite common these days, and if you’re enrolled in one of these plans, 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 Plan?

Aside from knowing how each type of insurance plan works, it’s important to note which procedures and treatments are fully covered and which ones are only partially covered by your plan. Here’s a brief breakdown of the 100-80-50 coverage structure:

  • 100% coverage – Fortunately, preventive dental care is often fully covered by most dental insurance plans. Regular checkups and cleanings are inexpensive, but also instrumental in preventing serious and costly oral health issues from progressing. These visits also include routine 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.

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! If you’re uncertain about the details of your coverage, don’t hesitate to speak with your dentist and their team; they’ll be happy to help you maximize your benefits!

About the Practice

Advanced Smile Design has served patients and families in the Willow Grove, PA area for several years. The practice is led by the awesome duo of Dr. Krunal Patel and Dr. Poorvi Gandhi. They’re pleased to offer a wide range of services including preventive, cosmetic, restorative options and more. If you have any questions about the article or what’s covered by your insurance plan, feel free to contact the practice online or over the phone for assistance: (215) 659-3334.

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