Most dental plans cover:
- Twice-yearly cleanings and exams
- Annual x-rays
- Restorations (fillings and crowns)
- Periodontics (treatment of gum disease)
- Endodontics (root canals)
- Bridges and dentures
Some also cover orthodontics. Many plans let you see any dentist, while some use a network of dentists.
You can read more about the various types of plans here.
Most insurers offer managed care plans designed to encourage wise use of dental benefits, with lower out-of-pocket costs for preventive services such as exams, x-rays and cleanings. Many plans also offer benefits for orthodontics, but pay a lower percentage for orthodontics than for restorative services such as fillings, root canals, etc.
Dental Benefit Plans
The different types include:
Under this “traditional” insurance plan, the plan pays dentists according to a formula—usually a percentage of the dentist’s fee, up to a “usual and customary” maximum. The dentist can bill insureds for the difference, or copayment. Most plans also have patients pay a deductible per visit or per series of treatments as well.
Preferred provider organizations (PPOs):
A dental PPO consists of a network of providers who agree to accept a certain discounted payment for their services. PPO plans give insureds financial incentives to use these “preferred providers” by paying higher percentages of claims they submit than for those submitted by non-preferred providers. Insureds pay the uncovered portion out of pocket.
Dental health maintenance organizations (HMOs):
In an HMO, dentists agree to provide specified dental services to members in return for a periodic per-capita payment—usually monthly. Payments do not depend on the number or type of services rendered, and the HMO accepts the financial risk for providing covered dental services to members.
Most plans require participants to use an HMO dentist, but some plans provide reduced benefits for members who use out-of network dentists. A participant may have to pay a deductible, co-payment, or any amount exceeding plan coverage levels.