The topic of dental insurance can be a daunting one. Across all the categories of dental programs, different plans offer certain benefits along with their own limitations. Each plan is unique, so understanding what your dental insurance covers is vital for ensuring you get the care you need.
What Is Covered By My Insurance?
Every dental plan has its own benefits and exclusions, but there are a few common benefits which the majority of plans share. You can generally expect your insurance plan to cover the following:
- Two preventive visits, like dental cleanings, per year
- At least some of the cost of preventive care, oral surgery, fillings, crowns and root canals
- Some will cover orthodontics, prosthodontics and periodontics
- Coverage in the 100-80-50 structure (100% of preventive care, 80% of basic procedures and 50% of major procedures)
As always, remember that no two plans are identical. These benefits are in no way universal and you should avoid making assumptions about what a plan might be willing to cover. Knowing up-front what your dental plan does and does not cover will save you unwanted stress later down the line.
Every dental insurance plan has an annual maximum. This represents how much the insurance can cover in a plan year. Once that maximum is exceeded, you will need to pay for all additional costs. You should pay close attention to your plan’s annual cap, especially should you find yourself in need of an unexpected oral surgery.
Specific dental services may have their own unique caps under insurance. Orthodontics, for instance, often has its own lifetime maximum.
Regular Dentist Visits
Most dental insurance plans will cover two preventive visits each year. Even so, you should know what in particular your plan specifies. Some plans will cover two visits per calendar year while others might require at least six months in between visits. Make sure you understand your plan’s wording when it comes time to schedule your next appointment.
Certain people will benefit from (or even require) more regular dental visits. Keep this in mind when assessing your plan’s preventive visit coverage. Some groups which fall into this category are:
- Pregnant women
- The elderly
Some plans may cover more frequent dental visits for these high-risk groups, while others may not offer specialized coverage. Individuals in these categories should carefully review their insurance policies to understand the specific coverage they have for dental care.
Dental Plan Exclusions
Some treatments might not be covered by a dental plan at all. You should pay close attention to know which are covered and which are not.
Preexisting conditions are often excluded from what dental insurance covers, meaning you may need to pay treatment costs yourself.
Keep in mind that exclusions in your plan, in some cases, might be covered by medical health insurance. Knowing what your medical insurance covers will be useful if you’re concerned about a particular exclusion in your dental insurance.
Reach Out To Gulf Coast Dental
Gulf Coast Dental has passionately provided dental services to the Gulfport community since 1969. We work to care for any and all of your dental needs. From our years of experience with oral health, we understand that maintaining dental care can feel stressful, so we’re prepared to tackle any questions or concerns you might have. Connect with us or schedule an appointment today and we’ll help you stay on top of your dental health!