Understanding the Basics of Private Dental Insurance
Dental insurance isn’t talked about nearly as much as medical insurance, so you might think it’s even more opaque than medical insurance. But it’s not so; dental insurance is often much more straightforward and more specific. You just have to be familiar with how it works, what’s covered, what’s not, why, and how to make the most out of your coverage.
The Key Factors in Private Dental Insurance
100-80-50 framework for coverage, where preventative care is totally covered (minus a co-pay), some routine corrective procedures are 80% covered, and other, less necessary procedures are covered at 50%. Then there’s cosmetic dentistry procedures. Those are often contested; insurance companies don’t want to cover something that’s purely about looks and not oral health.
The two main types of dentistry-specific insurance plans: DMO (dental maintenance organizations) and PPO (preferred provider organization). These will largely determine the details of the main factors in dental insurance.
Dental insurance plans have a few structural characteristics that will determine your budget and out-of-pocket costs for dental care:
- Focus on preventative care
- A network of local dentists (sometimes you can choose, sometimes one is assigned to you)
- Out of pocket costs (deductibles and co-pays)
- Yearly cap on coverage (the maximum amount the company will pay out per year on dental services)
If you want some really in-detail specs on how this works, check out this page.
What’s Typically Covered in a Dental Insurance Plan?
Dental services covered include:
- Regular dental cleanings and exams
- Regular x-rays
- Extracting teeth
- Cavity fillings
- Root canals
- Emergency dental procedures
Services that are partially covered include:
- Dentures
- Dental bridges
- Dental implants and implant crowns
Often, cosmetic procedures like teeth whitening aren’t covered, and you’ll need orthodontia-specific clauses in your dental insurance plan for those types of services to be covered.
Why isn’t Cosmetic Dentistry Covered?
Why don’t dental insurance plans cover cosmetic procedures like teeth whitening and tooth veneers? The same reason medical insurance doesn’t cover Botox injections or tummy tucks – they’re not necessary, and they serve no actual purpose besides subjective aesthetic improvements.
Insurance companies are all about minimizing their out of pocket coverage costs. Covering preventative care saves them money long-term because it prevents them from having to cover expensive oral health issues that might develop without regular dental cleanings, exams and upkeep. But covering something like teeth whitening doesn’t really do anything – it just costs them money.
What about Pre-existing Medical Conditions?
Similarly, oral conditions that are caused secondarily by other medical conditions often aren’t covered under dental insurance either, because, from the point of view of the dental insurance provider, those costs are an endless money pit of treating symptoms instead of causes, which fall under medical coverage, not dental.
See? The structure of these plans is pretty simple, pretty standard. Consider speaking with your provider about the specifics of your plan to make sure it’s tailored to your needs.