Dental Insurance and Service Coverage Explained


Preventive dental care will insure your teeth are healthy while decreasing the risk of gum disease and painful cavities. Many dental insurance plans cover preventive care with cleaning, and checkups. To keep your smile healthy, shop around for the best dental plan to suit your needs. The following describes different types of dental care insurance and treatment coverage options available. Dental insurance is usually divided into two types based on the co-pays and network providers.

The Managed Care Dental Insurance Plan:

This plan has a network of doctors that are providers, doctor visits and treatment must be done within the network so choices of dentists are limited to the network providers. Many in this dental plan are assigned a dentist for preventive care within the network.

The Preferred Provider Organization (PPO) Plan: This dental plan has a network of dental health care providers and you choose your dentists and service providers in the network. Going outside of the network may not be covered.

The Fee for Service Dental Insurance Plan:

Dental treatment services are paid at time of service. This plan allows choice of any doctors with individual dental service claims made after each visit. The insurance company then reimburses for any medical expenses covered in the dental plan. Many of the plans have set prices for certain services so check carefully to understand what the plan covers and possible limitations.

Dental Treatment Options and Cost Comparison:

In many dental plans, the least expensive treatment option will be followed by the physician because the dental plan will cover only the less costly procedure.

The patient must cover the additional cost if choosing a more expensive treatment option. For choices in treatment options, monthly premiums are higher but more dental services and procedures are available. Check the policy to find out who makes the treatment decisions. Many people prefer getting higher quality treatments and will opt for higher premiums and co-pays

Dental Treatment and Services Coverage:

Read the policy to find out if the plan covers preventive care for routine cleanings and checkups. Does it cover emergency services? Many plans cover both and list the services covered in the plan. Here’s a typical list of routine treatments in a full dental plan:

1) Full x-ray checkup–every three years,

2) Initial oral examination–once per dentist

3) Recall examinations–twice per year,

4) Cavity x-ray checkup– once per year

5) Teeth cleaning–twice per year

6) Topical Fluoride treatment–twice per year

7) Sealants–for those under age 18.

Routine Corrective Treatments Coverage:

Check what routine corrective treatments are included in your policy coverage. Many need more than preventive dental care to treat more serious dental problems. Some dental plans will cover 70-80 percent of the treatment costs, so find out how much will be paid in co-pays and maximum payout amount of policy. Here are the routine corrective treatments that many dental plans cover:

1) Restorative care – amalgam and composite resin fillings and stainless steel crowns on primary teeth

2) Endodontics – treatment of root canals and removal of tooth nerves

3) Oral Surgery – tooth removal, and minor surgical procedures such as tissue biopsy and drainage of minor oral infections.

4) Periodontics – treatment of periodontal disease including scaling, root planning and management of acute infections or lesions

5) Prosthodontics–repair of existing dentures and bridges.

Take advantage of being covered and visit the dentist on a scheduled basis with routine cleaning, and checkups. Keeping your teeth and mouth healthy requires following a preventive treatment plan. For more expensive treatments or surgery, ask the doctor about payment plans available to cover out of pocket expenses that insurance does not cover. Knowing your dental plan coverage and the treatment services it offers will also be an advantage when choosing additional plan options or changing policies.

Source by Elliot Bigman