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What dental procedures are typically covered by insurance? Let’s break it down (Part I)

Updated: Oct 26, 2021

In USA dental insurance coverage is quite pervasive. In fact, about 80% of Americans have either private insurance (172 million) or enjoy publicly funded dental benefits (87.6 million).

But how many people actually understand how insurance works? Have you ever asked yourself “what is covered by my dental insurance?” Are you taking full advantage of your benefits to keep your pearly whites healthy? Read on to learn about how dental benefits work and what dental procedures are covered by insurance.

How does dental insurance usually work?

When you sign up for dental insurance, you’ll pay a monthly premium, just like health insurance. Many plans also use a co-insurance structure. This means the insurance company will pay part of the cost of the procedure and you’ll be responsible for the remaining amount.

For example, PPO plans (we’ll explain more about this common type of dental plan later), use a 100/80/50 co-insurance structure. This means they’ll pay 100% of preventative care costs, 80% of the cost of basic procedures (such as a dental filling), and 50% of major procedures.

Many plans will have a deductible, which means you’ll have to pay for a certain amount before your insurance kicks in. Annual maximums are also common, which means they will only pay up to a certain amount within a one-year period.

You can buy stand-alone dental insurance. However, many people have dental benefits attached to their medical insurance. A stand-alone plan tends to be more flexible and offers more benefits overall. They also are not likely to have a waiting period which means you can get the care you need faster.

Dental benefits as part of your medical plan are more convenient. However, there are typically more limitations on the benefits such as when and how they can be used.

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