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Do You Know What Your Dental Insurance Plan Covers?

October 2, 2021

Filed under: Uncategorized — mosbydds @ 1:48 pm
Happy female patient talking to dentist at front desk

Do you know what procedures your dental insurance plan covers? If you’re like most people, you probably don’t spend a lot of time thinking about your insurance coverage. However, understanding the basics of how your plan works can help you get the most out of your investment. After all, you are likely paying a monthly premium, so it’s important not to let your insurance benefits go to waste! Keep reading to learn about the basic outline most dental insurance plans follow as well as some helpful tips to maximize your coverage.

What Is the 100-80-50 Coverage Model?

Dental insurance is designed to cover some portion of preventive treatments, restorative procedures, and orthodontic treatment. Although every plan is slightly different, most dental insurance providers follow what’s known as the “100-80-50” coverage model, which includes:   

  • 100% of Preventive Care – Routine dental exams, cleanings, and fluoride treatment.
  • 80% of Basic Procedures – Dental fillings, simple extractions, and root canals.
  • 50% of Major Procedures – Crowns, bridges, and dentures. 

Most dental insurance plans cover up to two routine checkups per year. So, if you have not seen your dentist in the past six months, don’t wait to schedule your next dental exam and cleaning. It likely won’t cost you a penny!

What Does Dental Insurance Not Cover?

Many patients are surprised to learn that dental insurance usually does not cover cosmetic dental procedures. This includes professional teeth whitening, veneer treatment, cosmetic bonding, and more. Cosmetic treatments help enhance the appearance of a person’s smile but are not considered “medically necessary” by insurance providers. Fortunately, there are other ways to reduce the out-of-pocket costs of cosmetic dentistry, such as low-to-no interest payments plans through CareCredit. 

Use It or Lose It!

Did you know that your dental insurance benefits likely do NOT roll over from year to year? Most dental insurance plans have what is called an annual maximum, which is the highest dollar amount it will pay for care in the calendar year. Depending on your policy, this amount can range from about $1,000 to $1,500. Whether you have $5 or $500 left on your annual maximum, if it’s not used by the end of the year, it instantly goes back to the insurance company and the amount is reset. Better use it or lose it!

Do Dental Insurance Plans Change?

Dental insurance plans change much more frequently compared to medical insurance. New premiums, deductibles, and benefits are often applied at the beginning of the year. So, if you like your current insurance dental insurance plan, do not wait until next year to take advantage of your benefits! Your policy could look significantly different when 2022 arrives.

Dental insurance is a monthly investment, so be sure to get your money’s worth! Talk to your dentist in Kingwood for more tips on how to take advantage of your dental insurance benefits.  

About the Author

Dr. Scott Mosby has over 25 years of experience providing comprehensive oral care. He leads the talented team at Kingwood Family Dentistry and gladly works with patients to maximize their insurance benefits. To learn more about how dental insurance coverage works, visit the Kingwood Family Dentistry website or call 281-359-6672.

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