What dental insurance covers | HealthPartners Blog
For many people, regular dental care is often placed low on the list of health care priorities – you’ll get to it when you get to it, right?
But your oral health is a big part of your overall well-being. In fact, studies show that gum disease can be linked to chronic conditions like heart disease, diabetes and more. This is a big deal, especially when you consider that the Centers for Disease Control and Prevention estimates that nearly half of all Americans over 30 show signs of gum disease.
Regular dental care is a must. But even if you have dental insurance, or you’re thinking of getting it, you still have to pay something, right? Let’s talk through types of coverage, major categories of dental care and what insurance is most likely to cover.
Basic dental insurance coverage and comprehensive dental insurance
When it comes to dental insurance, a detailed understanding of your plan helps ensure you get the care you need. Basic dental insurance covers preventive care and a few basic restorative services. A more comprehensive dental plan offers fuller coverage, paying a percentage of preventive care, basic restorative care and major services. But what procedures do these coverage types actually entail – and will your plan pay for them?
The four main categories of dental coverage
Dental coverage is broken up into four main categories: preventive care, basic care, major restorative care and orthodontics. Most plans take what’s known as the 100-80-50 approach to coverage. With this model, preventive services are covered at 100%, basic care is covered at 80% and major care is covered at 50%.
This means that after you pay your deductible, which is the set amount you’re expected to pay for specific dental services, your plan will cover a percentage of your remaining costs – like those mentioned above. After your plan pays, the amount left for you is known as your coinsurance.
Your deductibles and coinsurance rates are laid out for you in your summary of benefits when you enroll in coverage, so you know exactly what to expect.
Preventive dental care and diagnostics
Preventive care refers to a specific type of dental service that aims to prevent wear and tear, disease and disfunction. These dental services help you maintain better oral health and avoid future problems. Most dental insurance plans cover a minimum of two preventive visits per year at 100%, but some offer more.
What kind of dental services are preventive?
- Oral checkups and screenings
- Routine X-rays
- Cleanings and fluoride treatments
- Tooth sealing
Basic dental care
Basic dental care treats damage that has already happened, like toothaches and gum issues. So does that mean insurance covers fillings? Does insurance cover crowns? Yes, but it depends. Basic care is just that – basic! If you need more extensive work to restore your teeth, that can mean major restorative care.
Basic dental services partially covered by insurance
- Simple extractions (non-impacted)
- Tooth pain
- Treatment of gum disease
- Root canals
Major restorative care
Does insurance cover dentures or wisdom teeth removal? Yes – and these are just some of the dental services often considered major restorative care. This type of dental work requires more complex or extensive procedures. And while most dental insurance plans will pay a percentage of the cost of major restorative care, that percentage will typically be smaller than that contributed to a basic service.
Major dental services partially covered by insurance
- Complex extractions (impacted)
- Oral surgery and sedation
- Denture work
Does dental insurance cover braces or Invisalign?
Orthodontics is a specific type of dental service that assists with correcting or readjusting tooth alignment. Think braces, Invisalign®, retainers, headgear, palette devices and more. These services typically aren’t covered on individual or family dental plans. Group dental plans, like the kind you get at work, sometimes include orthodontics. But even then, an employer must elect to make orthodontic coverage available to employees.
Does dental insurance cover cosmetic procedures?
Cosmetic dental services, like whitening, veneers and bonding, are all about aesthetics. These services better the appearance of your smile. That can mean teeth, gums or the alignment of your bite. Since cosmetic procedures aren’t a medical necessity, they’re typically not covered under dental insurance.
What to look for in dental insurance coverage
If you’re looking for a dental plan that meets your needs, there are a lot of details to consider. Here are a few places to start.
Dental insurance quick tips
- Select a plan with an affordable annual deductible (typically $50 for an individual plan and $150 for a family plan) and confirm your plan’s coinsurance rate.
- Assess your plan for any waiting periods, so you can begin receiving care as soon as possible or when you need it most.
- If you want to continue going to your current dentist, check to see if they’re in network. If not, explore your new insurance’s network – you’ll likely find an in-network dentist near you.
Have more questions about dental insurance?
Our experts are ready to help you find a dental insurance plan that fits your needs.