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Dental Insurance: What All Does it Cover?

Almost 77% of Americans have dental benefits, usually in the form of private coverage as a part of their employer’s health benefits program. While Original Medicare does not include dental coverage, you can opt for a Medicare Advantage plan if you think you need to get dental insurance.

Here are the different types of dental insurance plans available in the market:

Preferred Provider Organization (PPO): As with preferred provider based health insurances, this dental insurance comes with a list of hospitals and dentists that are included in the plan. You can either visit someone who is a part of the set network or go out of the network and incur higher out-of-pocket costs.

Dental Health Maintenance Organization (DHMO): Like a health insurance HMO, these dental insurance plans have a set network of dentists that treat patients for no fee at all or a set co-pay. However, under a DHMO, you may not be allowed to visit an out-of-network dentist.

Discount or Referral dental plan: Coverage under this plan offers you certain discounts on dental services from selected dentists. Unlike other dental insurance or health insurance plans, the discount or referral plan doesn’t cover any of your treatment costs. Instead, the dentists you visit (must be from a predetermined list) agree to give you discounts on your final bill.

But what do these dental insurance plans include in their coverage? Dental insurance policies usually cover some portion of your dental treatment bills, including treatments like crowns, preventive care, fillings, root canals, and oral surgery for tooth extractions, and more.

Some insurance policies might even cover:

Periodontics procedures- the structures around the tooth

Orthodontics- braces and other cosmetic procedures

And prosthodontics- dentures and bridges

You usually get two preventive visits every year as a part of your insurance coverage. If you come under an individual insurance policy, it may take a year for prosthodontics and periodontics to be included in your coverage. On the other hand, you can opt for a rider to get orthodontics added to your policy for an additional fee.

To make it easier for you to understand, most dental insurance plans follow a 100-80-50 coverage rule. This means they cover 100% of preventive care charges, 80% of basic procedures charges, and 50% of major procedure charges. The list of major procedures included varies from plan to plan.