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The Meat and Potatoes of Dental Insurance and What to Know

Most of our patients have policies through their employers or a family member with the remaining having some form of a medicare plan. For this article we will cover the common type of plan seen through an employer or family member’s employer.

There are hundreds to thousands of plan variations but most have a number of common clauses and coverage schedules. On average, a dental plan will cover the following classification of procedures at the listed percentages. Deductibles usually around $50 to $100 annually will also apply to some of these classes. Classifications are usually listed as A, B, and C, Major and Minor or further broken down in to procedure type like Endodontic, Prosthodontic, Restorative, Perio and Preventive. Below is an example breakdown:

Service Classification Percentage Covered Deductible

General Services 0 No

Crown 50 Yes

Diagnostic 100 No

Endodontics 80 Yes

Implant Services 50 Yes

Oral Surgery 50 Yes

Orthodontics 80 Yes

Periodontics 80 Yes

Preventive 100 No

Prosthodontics 50 Yes

Restorative 80 Yes

Annual Maximum $1000

Your annual maximum is the total number of dollars that your insurance provider will pay out towards dental services in a given policy year.

Waiting Periods: 6 months at start of coverage date. Applies to all services not listed under Diagnostic and Preventive.

A waiting period is sometimes applied to a dental insurance plan during the first 6 months to year of a policy holder’s coverage. This means that a certain list of services will not be covered until the waiting period is up. Most policies do not have a waiting period on cleanings and diagnostic procedures like x-rays and evaluations.

If your policy is covered through an employer you might not have much choice in what the policy details will entail. This is generally determined between your company and the insurance provider. However, you can choose whether the plan is right for you and how it might help with receiving dental care. If you have any questions regarding your coverage. Call our office to speak with our insurance coordinator. We are happy to explore your policy for you.


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