Dental insurance helps members to offset the cost of the dental care and to maintain good overall oral health. Dental insurance is a combination of preventive services covered at 100% and lower out-of-pocket costs.
Most of the dental insurance plans focus on preventive care to catch signs and symptoms of dental disease early, as it could reduce the chance that more complex treatment will be needed later. If an issue does arise, dental insurance will usually help cover a portion of the treatment cost.
As part of 100-80-50 coverage structure, an example of dental coverage may be:
- 100% of routine preventive and diagnostic care such as cleanings and exams.
- 80% of basic procedures such as fillings, root canals and tooth extractions.
- 50% of major procedures such as crowns, bridges and dentures.
Deductible may apply to these services, may be waived for preventive and diagnostic services.
Some select procedures like orthodontia, cosmetic procedures (like teeth whitening) and the pre-existing conditions (like a missing tooth) are not covered by many dental insurance plans.
Dental insurance plans have some limitations, such as a waiting period – a period of time before the member is eligible to receive benefits; annual maximum- the total amount your dental insurance will pay for your coverage during a 12-month period. For instance, if your annual maximum is $1,500, you pay for all additional costs after your dental insurance has paid $1,500 for your care. However, only 2% to 4% of Americans typically exceed their annual maximums.