Dental insurance benefits usually expire at the end of the calendar year. As the conclusion of 2022 gets closer, therefore, you may be wondering how you can get the most out of your plan before it resets on January 1. To help you out, we’ve put together this basic guide on what a typical dental plan covers. It will help you know what to expect the next time you visit your dentist!
Preventive Care
Preventive care is the foundation of a healthy mouth. Dental insurance plans recognize this, so they usually cover two checkups and cleanings each year at 100%. That means you can enjoy a clean and fresh mouth for nothing out of pocket! In many cases, preventive care is even exempt from a plan’s deductible.
Minor Restorative Care
Often, minor restorative care is covered at 70 – 80%, after you take care of your plan’s deductible. Insurance plans can vary in what they define as “minor” services, but this category often includes fillings and simple extractions, as well as nonsurgical gum disease therapy. In some cases, root canal therapy is also included.
Major Restorative Care
Major services are usually 40 – 50% covered, up to the amount of a plan’s annual maximum. (An annual maximum is the highest dollar amount that an insurance company will pay out for services within a calendar year.) Often, the cost of a major procedure will exceed a plan’s maximum. To reduce your out of pocket expenses, you may choose to schedule part of your treatment in 2022 and the rest in 2023, so you can use two annual maximums.
Most oral surgeries, such as wisdom tooth extractions, are usually considered to be major services. Crowns, bridges, and dentures also typically fall into this category. Root canal therapy may be considered a major treatment as well.
What Isn’t Covered?
Dental insurance plans commonly exclude purely cosmetic services, such as teeth whitening, veneers, and other procedures which have the main purpose of enhancing the look of the teeth. Orthodontia is also excluded from many plans. Dental implants may be another service that is not covered; however, more and more plans are beginning to include them as a major restorative procedure.
If you would like any procedure that your insurance does not cover, talk to your dental team about other payment options, such as financing or an in-house discount plan.
No two dental insurance plans are exactly alike. However, armed with the above information, you are now in a better position to understand your coverage and use it to your greatest advantage!
Meet the Practice
Dr. Gary C. Nawrocki is a general dentist with more than four decades of experience. He operates an insurance-friendly practice, so be sure to ask our team how we can help you use your policy. We also offer a convenient in-house discount plan that can reduce your out-of-pocket fees for most services. To learn more about us and how we may be able to help you enjoy a healthy smile at a reasonable price, contact us at 321-783-7514.