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Dental Insurance Coverage Options
Preventative Care
According to the U.S. Department of Health & Human Services (2020), preventative dental procedures typically include regular check-ups, cleanings, and X-rays, as well as treatments and procedures like fillings, crowns, and bridges.
A regular dental check-up typically includes an examination of one’s mouth to check for any signs of decay, infection, or other abnormalities. During the check-up, the dentist will also look for any soft tissue abnormalities, such as lumps or bumps, and will assess any existing dental work for signs of wear or damage. Additionally, the dentist may also take X-rays to get a better look at the teeth and gums, and may also clean and polish the teeth to remove any plaque or tartar buildup (American Dental Association, 2020).
Basic Care
Basic dental procedures include fillings, crowns and bridges. Fillings are used to fill cavities and restore teeth damaged by decay, while crowns are used to cover damaged or misshapen teeth, and bridges are used to replace one or more missing teeth (American Dental Association, 2020).
Major Care
In a health care sharing ministry (HCSM), members follow a common set of religious or ethical beliefs and contribute — typically monthly — a payment, or share, to help cover the qualifying medical expenses of other members. HCSM’s are consistently growing in popularity as other insurance carriers continue to raise monthly premiums.
Coverage for a Dental Plan
Regular Check-ups
Medicare dental check-ups are preventative care appointments.
Cleanings
Dental cleanings are professional teeth cleanings that remove plaque and tartar to prevent cavities and gum disease.
X-Rays
Dental X-rays are images of the teeth and jaws that help dentists diagnose and treat dental problems.
Treatments & Prodedures
These will particularly include: fillings, crowns, and bridges.
What is the difference between in-network and out-of-network benefits for a dental PPO plan?
IN-NETWORK
In-network benefits for a dental PPO plan may include discounted services and copayments.
OUT-OF-NETWORK
Out-of-network benefits may include reimbursement for services provided at higher rates (National Institute of Dental and Craniofacial Research, 2020).
It is important to note that out-of-network benefits may offer lower coverage and more expensive services than those provided by in-network providers (American Dental Association, 2020).
What is a Dental Provider Network?
A dental provider network is a group of dentists that have contracts with an insurance company to provide covered services at discounted rates (Ruggiero, 2019). These dentists are usually located within a certain geographic area and they offer a variety of services, including preventative care, restorative care, and specialty care. It is important to check with a dental provider network to see which dentists are covered by a particular dental insurance plan.
PPO plans may be offered, which are Preferred Provider Organizations. These plans allow for greater flexibility in terms of which providers can be used, as well as the cost of care (National Institute of Dental and Craniofacial Research, 2020). It is important to review the terms and conditions to determine which type of plan best suits one’s needs.
What are Different Types of X-rays?
X-rays are often used to detect any abnormalities in the teeth and gums that are not visible to the naked eye.
An important thing to keep in mind is that coverage for an x-ray will vary according to type of x-ray. For example, a panoramic x-ray would likely not be covered under preventative dental coverage in a standalone dental plan.
Intraoral X-rays
Intraoral X-rays are taken of the individual teeth.
Occlusal X-rays
Occlusal X-rays are taken of the whole mouth.
Periapical X-rays
Periapical X-rays show the entire tooth from its crown to the roots, and panoramic X-rays provide a view of the entire mouth, including the teeth and the jaws (American Dental Association, 2020).
Panoramic X-rays
A dental panoramic x-ray may be necessary when a dentist needs to get a full view of a person’s mouth, including the teeth and jaws (American Dental Association, 2020).
This type of x-ray is typically used to detect any abnormalities not visible to the naked eye, such as impacted teeth, cysts, or tumors (American Dental Association, 2020).
Frequently Asked Questions
What is a Waiting Period?
A waiting period is a specific period of time that must pass before certain benefits under a dental insurance plan become available.
Waiting periods typically range from six to twelve months, depending on the insurance company, and may apply to pre-existing dental conditions as well as certain dental treatments.
It is important to be aware of any potential waiting periods when selecting a dental insurance plan so that a person can make an informed decision.
What is the Missing Tooth Clause?
The missing tooth clause is an important provision when considering dental insurance plans, which states that policies will not include coverage for replacement of missing teeth (American Dental Association, 2020).
It is important to be aware of this clause when selecting a dental insurance plan so that a person can make an informed decision.
What is Periodontics?
Periodontics is the branch of dentistry that focuses on the prevention, diagnosis, and treatment of gum diseases (National Institute of Dental and Craniofacial Research, 2020).
This includes diseases such as gingivitis and periodontitis, which affect the gums and the structures that support the teeth. Periodontists are specially-trained dentists who specialize in treating and preventing gum diseases.
They are also experienced in replacing missing teeth with implants, bridges, and other prosthetics (National Institute of Dental and Craniofacial Research, 2020).
Do Dental Plans Cover Dental Implants?
Stand-alone dental plans may not cover dental implants, as it is considered a cosmetic procedure and falls outside of most dental plan coverage.
However, some dental plans may provide partial coverage for implants, depending on the plan provider (American Dental Association, 2020).
What Coverage May A Typical Dental Plan include?
Typically, a dental insurance plan includes coverage for preventive care, such as regular check-ups, cleanings, and X-rays, as well as treatments and procedures like fillings, crowns, and bridges (U.S. Department of Health & Human Services, 2020). Moreover, Standalone Dental Plans (SDPs) provide members with the ability to receive coverage for these types of treatments and procedures at a more cost-effective rate. Therefore, investing in an SDP can be an effective way for insurance providers to reduce costs and provide comprehensive coverage for their members (Kaiser Family Foundation, 2020).
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