No one likes to open a bill they received in the mail only to discover they owe a large amount for a treatment they expected insurance to cover, especially when medically necessary. There are too many insurance companies to name, all with their own unique policies, coverages, deductibles, and co-pays. It can be challenging to know what to expect with your dental insurance, with most insured patients asking themselves What does dental insurance cover?
Rhoades Family Dentistry has been treating families in and around the Kansas City metro for decades, working with countless insurance companies to get maximum coverage for our patients. Continue reading for an explanation of dental insurance, including what most plans cover and what they don’t, and about options we offer patients without insurance.
What Most Dental Insurance Plans Cover
No two dental insurance plans are the same; every plan is unique to the individuals covered. However, most insurance plans cover similar treatments and preventative care, including cleanings. So, what does dental insurance cover? Depending on the coverage you signed up for during open enrollment, your plan may or may not cover the following most commonly covered dental treatments:
Cleanings
Most basic dental insurance plans cover cleanings since they’re considered preventative treatment. Your individual insurance coverage may only cover a portion of the cleaning, especially if you use an out-of-network provider or require more than two cleanings per year. However, most dental insurance companies, whether you choose a basic or premium plan, cover dental cleanings.
Fillings
Because dental fillings are considered restorative care, most insurance plans will cover them. However, there’s usually a coinsurance fee. For example, let’s say your insurance covers fillings at 80% – you would be responsible for 20% of the filling. Though most insurance plans cover fillings, they may not cover a replacement filling.
X-rays
Dental x-rays are considered preventative care, used to take a closer look at your teeth to determine whether you need fillings or other dental work. It gives dentists a closer look at your teeth, revealing what the naked eye can’t see. Most insurance plans cover X-rays, usually between 80%-100%. Depending on your individual plan, coverage varies for comprehensive, panoramic, and bitewing X-rays.
Extractions
While coverage usually depends on the tooth that’s being extracted, most insurance plans cover extractions and consider them basic care. Simple extractions that involve removing a visible tooth that’s not impacted or broken are often covered at 80%, leaving you a 20% coinsurance. More complex extractions, such as wisdom teeth removal, often carry a higher out-of-pocket cost.
Sealants
Sealants are considered preventative care and are often covered for children on most insurance plans. Certain factors will determine whether your plan covers sealants, such as the age of the patient, the tooth getting treated, the frequency of sealant application, and whether a provider is in or out-of-network.
Root Canals
Unlike fillings, root canals are considered a major procedure, and coverage varies. Some plans will cover root canals at 50% while others may cover 70%, leaving you responsible for the coinsurance.
Coverage varies based on your deductible, coverage, budget, and the option you chose during your open enrollment. Some insurance companies will pay more for treatments, while others may pay less or won’t cover certain treatments. Again, each plan is unique, and it’s best to contact your insurance’s customer service to understand what’s covered and what isn’t.
What Most Dental Insurance Plans Don’t Always Cover
Some people choose basic dental plans that don’t cover major dental treatments, like dental implants. Depending on your plan, the following services most likely won’t be covered in full by your insurance:
Pre-existing Conditions
If you just enrolled in a new plan, your new insurance most likely won’t cover or will only partially cover a pre-existing condition you had before enrolling. Whether you had a missing tooth, needed a crown, or other dental procedure or treatment done, your insurance most likely won’t cover the treatment if you needed it before you enrolled.
Dental Implants
Dental implants are considered a major procedure that involves placing an implant inside the bone, a process that most often requires an abutment and crown. Most insurance plans don’t cover the implant, often leaving patients responsible for 100% of the implant. However, some plans do cover a percentage of similar yet less expensive options, such as a bridge, leaving the patient with coinsurance.
Braces
Braces are one of the most common orthodontic treatments, offering patients a straighter smile that corrects overbites, underbites, and crowded teeth. Though braces are common, most insurance companies won’t cover them unless they’re medically necessary; insurance will usually deny coverage if braces are for cosmetic purposes. Coverage varies depending on the individual plan, the patient’s age, and whether the treatment is medically necessary.
Whitening Treatments
Because whitening treatments are strictly cosmetic, dental insurance doesn’t cover them. Just because insurance won’t cover a professional whitening service, steer clear of DIY dental treatments, as they can harm the enamel; booking a professional whitening treatment with your dentist is the safest option for your teeth.
What if I don’t have Dental Insurance?
Not having dental insurance shouldn’t hold anyone back from getting routine dental cleanings and treatments they need to maintain excellent oral health. At Rhoades Family Dentistry, we process and file all claims for all insurance companies that allow patients to see any doctor of their choice.
While we accept and file all major insurance, we want dental care to be accessible to everyone, regardless of insurance or treatment. We accept all major forms of payment, including, but not limited to, the following: MC, Visa, American Express, Discover, debit cards, personal checks, and cash. We also offer Care Credit, a healthcare credit card that helps patients pay for medical expenses, including dental care, in installments, rather than paying up front.
We want all new patients to get the dental care they need. Whether we’re “in-network” or “out-of-network”, we’re happy to do a complimentary benefits check to determine your coverage.
Let Rhoades Family Dentistry Help with a Complimentary Benefits Check for Your Insurance
Rhoades Family Dentistry’s team of professionals includes dentists and hygienists who have extensive schooling and training to perform dental treatments and are glad to provide a courtesy benefits check for your insurance.
Dr. Hahn and Dr. Driscoll are members of the American Dental Association, the Academy of General Dentistry, and the International Association of Orthodontics, among many other organizations. Rhoades Family Dentistry offers dental care for the entire family, including routine cleanings, preventative maintenance, fillings, and more. Dr. Hahn and Dr. Driscoll care about your family’s oral health and are here to recommend the best oral hygiene practices for your entire family, including Invisalign and braces, cosmetic dentistry, dental implants, whitening, and more.
Book an appointment today by scrolling up and clicking “BOOK AN APPOINTMENT” on the top left of your screen or by calling (913) 782-8900. We look forward to serving you by providing excellent dental care and giving your family healthy, whiter smiles!
