Dental and Orthodontic Insurance Coverage

Tooth model | Dental InsuranceMajority of the dental insurance plans available give full coverage of preventive care such as annual or semi-annual office visits for cleaning, X-rays, and sealants. Some dental insurance plans also offer orthodontic insurance. Basic procedures like treatment for gum disease, extractions, fillings and root canals, with deductibles, co-pays and co-insurance determining the patient’s out-of-pocket expenses.

Deductible

This is the amount you have to pay before your benefit plan begins to pay the cost of your dental treatment. Most deductibles do not apply to Preventative visits.

Maximum

The maximum is the most money a dental insurance plan will pay for your dental care and treatments within a benefit period. Once you reach the maximum amount, you will be responsible for paying any costs for the remainder of the benefit period.

Coinsurance

A dental insurance plan pays a percentage of any dental treatment cost, and you are responsible for paying the remaining balance. The amount you pay is called coinsurance, and it is part of your out-of-pocket cost after your deductible is reached.

Reimbursement Levels

Procedures that are diagnostic and preventive (such as cleanings and checkups) are typically covered by your dental insurance plan at the highest percentage (for example, 80 to 100% of the plan’s contract allowance). This gives you a financial incentive to get regular checkups and cleanings to prevent the need for more extensive procedures.

Basic procedures (such as fillings and gum treatment) are usually reimbursed at a slightly lower percentage (for example, 70 to 80%).

Major procedures (such as crowns and fillings) are usually reimbursed at a lower percentage (for example, 50%).

Orthodontic

Dental insurance plans can be purchased to cover braces and usually come with a lifetime limit on orthodontics. Most of the dental insurance for braces and other orthodontic procedures only covers children, but these plans can be customized to include adults as well.

The costs of children’s orthodontic treatments and orthodontic insurance for adults are based on plan design and industry type. These dental insurance plans can be offered through an employer or on an individual basis. Check out our other insurance policies.

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