When you buy dental insurance, that plan helps pay for care when you see the dentist. Dental insurance covers many—but not all—dental procedures, and only up to a limited dollar amount. For instance, many plans cover preventive care like exams and cleanings in full right away, but only cover more complex procedures in part and after a waiting period. Much of the coverage depends on your insurer, state, and plan type. 

How Dental Coverage Works

Dental insurance differs from medical insurance in the intention of the plan and how coverage is structured. Medical insurance anticipates the cost of expensive, unexpected care (such as a trip to the emergency room), and helps make thജat care more affordable. In contrast, while every dental insurance plan varies, most focus on preventive care, making good, lifelong oral health easy and affordable.

“Calling a dental insurance plan a dental ♔benefit plan better describes the actual product,” said Mark A. Vitale, DMD, a dentist at Edison Dental Arts in Edison, New Jersey. “You pay a fee or premium for a benefit that has a distinc𓃲t limit—in most cases, $1,500.”

澳洲幸运5开奖号码历史查询:Dental insurance plans break out coverage for three dꦫifferent levels of procedures that typically include these types of care. 

• Preventive: Cleanings, exams, and routine X-rays
• Basic: Fillings, routine tooth extractions, and non-routine X-rays
• Major: Crowns, bridges, dentures, and implants

You pay a monthly premium amount just to get plan coverage. However, you may not get immediate access to all its benefits. Most dental policies require a six- to 12-month waiting period for basic or major work—though there are some 澳洲幸运5开奖号码历史查询:dental plans with no waiting period. Pre-existing conditions like missing teeth and some major procedures and services such as adult braces may never be covered. (Our list of the 澳洲幸运5开奖号码历史查询:best dental insurance for braces notes some good ones that do.)

Unlike medical insurance, dental plans usually also limit how much they’ll pay per year per patient (though there are plans—mostly HMOs—that have 澳洲幸运5开奖号码历史查询:no annual maximum). The majority (63%) of dental insurance plans offer coverage for up to $1,500 worth of services. Once you exceed your plan's limits, the plan won't pay anything else toward your dental care✅ that yea♏r. Vitale said these limits haven't increased much in the past 40 years, although dental costs have tripled due to inflation and expected price increases. 

Dental insurers pay only a percentage of your costs, especially for more expensive procedures. For example, the 澳洲幸运5开奖号码历史查询:best dental insurance plans might pay 100% of the costs for preventive care treatments, 80% for basic care, and 50% for major care. But it’s not unusual to see plans whose 🎃coverage is more like 10🍎0%/50%/40%. So, despite coverage, you’ll almost always also pay for each type of service—for example, 50% or a flat $50 per tooth filling. 

Your dental insurance may also include a 澳洲幸运5开奖号码历史查询:deductible—an amount you must pay out of pocket ⛦before your dental coverage starts paying for💞 dental services. A typical deductible is $50 or $100. 

Your dental coverage may be influenced by where you buy the plan. You can sign up for a dental plan when you buy an 澳洲幸运5开奖号码历史查询:ACA (Affordable Care Act)  healthcare plan. (You can’t buy a dental plan on the ACA Marketplace without buy🐻ing a health plan.)

澳洲幸运5开奖号码历史查询:Marketplace dental plans are categorized as “high” or “low.” The high coverage level has higher monthly premiums, but you pay less when you visit the dentist. A low coverage level offers lower monthly premium payments but higher costs for a dentist visit. 

How Dental Insurance Covers Dental Procedures

Dental Insurance Coverage f⭕or Preventive Services

Most dental insurance plans cover preventive procedures. “Dental insurance coverage hopes to protect patients from developing painful, seri😼ous oral health problems by covering 100% of preventive care costs such as checkups and cleanings,” Vitale said. 

There are us⛎ually limits on how often you can get X-rays or cleanings. Typically, you’ll benefit from two visits a year. There may also be restrictions on other covered procedures through price caps, limitations, or other exclusions.

Dental Insurance Coverage for Basic Services

Dental insu🍷rance typically covers only a portion of the costs for basic work such as tooth extractions, fillings, and some emergency pain relief. You’ll pay either a percentage or a flat rate for the cost of care, but your percentage of responsibility will be lower than for major services.

The insurance company’s provider network may determine coverage percentages. For example, your insurance may cover 80% of a filling’s cost when you see a dentist within the plan’s network, but only 60% of the cost if the dentist is outside the network. 

Dental Insurance Coverage for Major Services

Major services can include higher-cost services and procedures, which, unfortunately, are covered at the lowest cost percentages. You could pay a🍎s much as 80% or more of the final bill—or the whole thing if your insurance doesn’t cover that particular major service. 

Major services may include gum disease treatment, root canals, crowns, and dentures, along with implants,💝 bridge repair and construction, and oral surgery.

Many of these more costly and involved dental needs afflict older populations. Whether 澳洲幸运5开奖号码历史查询:older adults need an insurance plan may depend on the care they've put into their teeth so far, Vitale said. Those who ha🍬ven't gone for regular checkups and cleanings may need to weigh cost👍s more carefully, because ongoing care costs may be higher. 

Vitale said he struggles with older patients who only had cleanings and exams every three to four years and are now coming in for help decades later. “They say, 'Doc, I have insurance now, so let's get procedures done.' That's a big challenge," Vitale said, due to a plan’s limits and the types of procedures covered.  

What Does Dental Insurance Not Cover? 

Most dental insurance plan꧋s restrict coverage by using fine print, Vitale said, limiting payouts with:

• Exclusions: Referred to as “non-covered services,” exclusions are treatments the plan doesn't cover under any circumstance. For example, if your current dental insurer didn't pay for a tooth’s extraction, it won't pay to replace the tooth.
• Frequency limitations: These limitations cap how often a procedure can be performed on a tooth. For example, let’s say you form decay under a crown you got three years ago, necessitating replacement. It will not be covered if the plan has a frequency limitation of five or 10 years.
• Alternative treatments: Insurance companies may reimburse at a rate for the least expensive treatment, even if it isn't ideal—for example, a partial, less-expensive denture instead of a tooth implant.
• Waiting periods: This refers to how long you must wait after signing up for the plan before your coverage kicks in. For example, your insurer may require you to pay one year of premiums before covering a percentage of an implant’s cost. Some insurers offer 澳洲幸运5开奖号码历史查询:dental plans with no waiting per🦄iods.
• Pre-existing conditions: Unlike ACA health insurance, dental insurance plans are not required to cover pre-existing conditions. Some plans do and others don’t. 
• Networks: Dental♓ health maintenance organization (HMO) plans may not reimburse you at all for out-of-network dentists. A dental preferred provider organization (PPO) plan would allow you to go out-of-network for a higher charge. Once they find a trusted dentist, most people don't like switching providers, Vitale said—so if your dentist is important to you, so is the network.
• Non-duplication of benefits clause: This clause doesn't allow you to "stack" dental plans to cover a procedure despite premiums being paid to two different plans. For example, your spouse's insurance won't cover the other 50% of an implant's cost, even if your insurance only covers the first 50%.

Other things dentℱal insurance m♏ay not cover include:

• Cosmetic services
• Orthodontic services
• Some pain or anxiety relief medications
• Experimental procedures

Alternatives to Dental Insurance Coverage

Some dentists offer in-office loyalty plans, which allow for cost savings and increase access to care for man🥂y patients who don’t want to pay high insurance premiums or don’t believe they need insurance to go to the dentist.

There are also 澳洲幸运5开奖号码历史查询:dental discount savings plans🐈. These are similar to membership plans, such as Costco’s, Vitale𒅌 said. You buy into the plan and in exchange, you get a discount from dentists who participate in that particular plan.

The Bottom Line

​​Look for a good, honest agent and don't just buy an insurance policy online based on marketing, Vitale suggested. Instead, speak with someone about the pros and cons of the plans available to you. Understand the policy and look for potential nuances that could lead to a rejected dental claim. 

Ensure your dentist understands your needs and coverage and is willing to work with you. Vitale said he sits down with patients to review premium costs versus average annual expenses. While some years might be more expensive, most aren't, particularly if you regularly visit the dentist for cleanings and oral health. Finally, if you do buy a dental insurance plan, use it. "It is foolish to pay a premium and not use the coverage," said Vitale.