What Does Dental Insurance Cover

Do Orthodontic Benefits Cover Braces

Does dental insurance cover dental implants? | Dr. Ron Receveur, New Albany Implants

Many times, orthodontic benefits do cover braces, but it depends on the plan. Typically, the most basic plans wont include any orthodontic coverage, while the more comprehensive and expensive plans will. Every insurance company outlined above has a plan that might cover braces or clear aligners.

This coverage also can extend to other braces types , but to be sure, you should double-check with your dentist/orthodontist and insurance provider.

Best Dental Insurance For Implants Of 2022

Anthem Essential Choice Platinum Best Overall 1 None for preventative 6 months for Major $ 50 per individual $ 150 for family
Renaissance Plan II $ 50 per individual $ 150 for family
United Healthcare Premier Plus Best for No Waiting Periods 1 $ 50 per individual $ 150 for family
Physicians Mutual Preferred PlusBest for Seniors None for preventative 12 months for Major None
MetLife VADIP High Program Best for Veterans 2
Swan DHMO Best for Group Benefits 5 None

Coverage For Different Types Of Services

Dental benefits cover specific treatments and services. Your plan will outline what dental services are covered and the amount your insurance company will pay for each service. The covered services are usually broken down into three categories:

  • Preventive care
  • Basic services
  • Major procedures

Your plan will specify what percentage of the cost of a service it will pay. For example, lets say your plan pays 100% of preventive services, 80% of basic care, and 50% of major procedures. If you go to the dentist for a major procedure that costs $800 after your deductible, the insurance company would pay $400 and youd pay the remaining $400.

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How Much Does A Dental Payment Plan Cost

The cost depends on the plan you choose and your oral health.

The monthly fee is set by your dentist, based on an examination of your dental needs.

If you choose a comprehensive plan, your dentist will examine you. Depending on how much time, care and treatment youll need over the year theyll put you in a band with a set fee.

You could move up or down between fee bands if your oral health improves or deteriorates. You might also have to pay a joining fee.

As youre paying the dentist directly, be aware that prices might vary widely between practices.

How Much Does Dental Insurance Cost

Like health insurance, there are a variety of dental insurance plans that offer a range of coverage options. Depending on your familys needs and your budget, there are several affordable dental options available for you to choose from Humana. To calculate the cost of dental insurance for you and your family, first identify your specific needs and then choose a plan that meets those needs.

  • Do you have children that need regular, preventive care?
  • Will you or your children need orthodontic care?
  • Does anyone in your family require care for dental issues?
  • As we age, we tend to need care for crowns and other procedures. Are you or your family members in need of such care?
  • Have you been to the dentist in the last year?
  • Do you visit your dentist on a regular basis?
  • Do you have any medical conditions such as diabetes or hypertension?

Be sure to do the math. Often your annual premium is less than the cost of 2 visits to your dentist per year for regular checkups. You can call your dentist and ask for the price of a visit if you pay yourself, without insurance. Its likely that dental insurance is cheaper than paying for 2 visits out of your pocket. Plus, you get the added benefits of having dental coverage that will save you money in case unexpected dental issues come up.

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When Would I Need Dental Cover

If your teeth are healthy and you only really visit the dentist for an annual check-up, you probably dont need to pay for dental insurance.

However, you might still want to perhaps because the option of emergency care gives you peace of mind.

But if your dental health isnt great and you need regular treatment, insurance could be a cost-effective way to pay for it.

Similarly, if you cant find an NHS dentist, or you simply want to use a private dentist, it makes good financial sense to get dental cover.

Be aware that while NHS treatment is capped and typically much cheaper than going private, you usually still have to pay for it.

You might also have to wait longer than you would for private treatment.

NHS costs vary across the UK:

Finding an NHS dentist:

Popular Dental Insurance Providers


CIGNA is a common dental insurance provider. There are three types of plans to choose from, depending on the patients needs and how many family members they have.

Cigna Dental Preventive

The lowest plan starts at $19 a month per person and covers 100 percent of preventive services. Restorative services and orthodontics are not covered. This plan does not include a deductible.

Cigna Quality Provider Network Dental Coverage

The middle plan starts at $30 a month per person and covers 100 percent of preventive services. Deductibles range from $50 to $150 .

Restorative services are covered up to $1,000 per year .

This plan does not cover orthodontic treatment.

Cigna Highest Level of Dental Coverage

The highest plan starts at $35 a month per person and covers 100 percent of preventive services. Deductibles range from $50 to $150 .

Restorative services are covered up to $1,500 per year . Lastly, orthodontic treatment is covered up to $1,000 .

Orthodontic insurance has a separate coinsurance and deductible.

Other popular providers with similar dental insurance plans include:

There are also several dental assistance programs that can help those with low-income.

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Hmo Or Health Maintenance Organization Plans

With an HMO, youre required to see dental providers in the insurance network.

Pros: Preventive services cleanings and X-rays will be 100% covered, while basic procedures come with a co-pay. You may not have a deductible or maximum annual limit and premium payments will likely be lower.

Cons: Major or restorative procedures may come with less than 50% coverage or no coverage at all. You wont have a large choice of providers.

This plan is best if: You dont anticipate needing any major dental procedures in the near future. You have no provider preferences as long as basic dental work is covered financially.

If you already have a dental provider you trust, see which plan their office recommends.

Most plans wont immediately cover pre-existing conditions or reimburse for major procedures completed before you got insurance. When in doubt, ask whats covered and when.

Keep in mind theres always a possibility you may need a procedure you dont anticipateand it may not be covered by your policy. The higher your premium, the more likely you are to have coverage for more extensive work. Your dentist will often tell you which procedures youre likely to need down the line.

What Does Dental Care Cost If Youre Uninsured

Does Dental Insurance Cover Dental Implants?

Like the price of insurance, the out-of-pocket price of dental care varies somewhat based on where you live. Youll pay more in an area with a high cost of living.

The ADA Health Policy Institutes 2013 Survey of Dental Fees compiled the average U.S. costs for some common procedures:

  • Teeth cleaning: $85.
  • Complete series of X-rays: $124.
  • Silver dental filling: $125.
  • Front tooth root canal: $762.
  • Bicuspid root canal: $879.
  • Molar root canal: $1,111.

An important note usually a root canal is followed by a crown, although the procedures are charged separately.

Average prices for root canals, compiled by FAIR Health, vary based on the tooth.

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Deductibles Copays And Coinsurance

An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. For example, if the deductible is $200, and the covered individuals procedure is $179, the insurance does not kick in and the individual pays the entire amount. Copays, which are a set dollar amount, may also be required at the time of the procedure.

When a dental deductible is met, most policies only cover a percentage of the remaining costs. The remaining balance of the bill paid by the patient is called coinsurance, which typically ranges from 20% to 80% of the total bill.

Costs and what procedures are required may also differ based on the patient’s age. Seniors on Medicare, for instance, will have a different definition of what constitutes the best dental insurance possible than other age groups.

Most dental insurance plans follow the 100/80/50 payment structure: They pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.

Is Dental Insurance For Implants Expensive

The type of policy you choose affects what you pay. Usually, the most affordable dental insurance plans often do not cover restorative work the full coverage dental plans, which tend to have higher monthly premiums, are the ones that will cover procedures like implants.

Another option is to invest in a dental savings plan. Unlike insurance, a dental savings plan has pre-negotiated a discount on your behalf. Participating providers will bill the rate that the savings plan members pay directly to the practice. These plans are often less expensive per month than dental insurance and can offer significant savings on dental implant treatment.

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Ppo Or Preferred Provider Organization Plans

With a PPO, you pay lower fees to see certain in-network or preferred providers.

Pros: The insurance network pays more than they might with an indemnity plan or HMO plan. You arent required to see in-network providers, but you save money when you do.

Cons: Youll pay more if you see a provider out of the network. PPO plans often come with a maximum amount theyll reimburse in a calendar year. Some procedures may not be covered or have a waiting period before coverage starts.

This plan is best if: You dont need major dental work right away, but want to be prepared in case you need it in the future. Youd like some flexibility in your choice of dental providers but dont want to pay high premiums.

What Is Covered Under Humana Dental

  • 100% of preventive exams are conducted.
  • The frequency of routine cleanings is 100%.
  • A preventive exam requires 100% x-rays.
  • 60 to 100% of the filling is filled.
  • 60-70% of emergency care is provided by hospitals.
  • Extractions of simple samples: 60 to 100%.
  • 60 to 100% of patients have undergone oral surgery.
  • The Crowns: 50 to 60%.
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    Does Dental Insurance Cover Night Guards

    Some dental insurance companies cover night guards but its best to check with your insurance company. If you need a night guard in order to protect your teeth or treat a condition like TMJ or Bruxism your medical insurance may cover the cost of the night guard if your dental insurance provider doesnt. If you need any kind of customized dental appliances or equipment to combat a medical problem or something that could become a medical problem its a smart idea to check with your medical insurance to see if they will pay the cost for that appliance. If they wont cover it then you can submit it to your dental insurance provider. If you have double insurance coverage one of the policies may be able to cover the cost of dental appliances.

    Are Invisible Aligners And Braces Covered By Guardian Dental Insurance

    What does Guardian dental cover? With Guardian dental insurance, invisible aligners and braces are considered forms of orthodontic treatment rather than purely cosmetic procedures. Therefore, they are covered under its top-tier plan. Invisalign is one of the best-known names in the clear aligner industry, but is Invisalign covered by insurance? Yes! Does Guardian cover Invisalign? Also yes! While Invisalign is one of the biggest brand names for invisible aligners, Guardians insurance coverage extends to other forms of clear aligners as well. So does Guardian cover Byte? Yes, Guardian dental also covers invisible aligners companies like Byte and SmileDirectClub. With this being said, however, Guardian only covers orthodontic treatment for those who are 19 years old or younger and covers 50% of the cost up to the lifetime limit for the plan.

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    As Mentioned Previously Some Insurance Companies Will Not Cover The Initial Veneer Procedure But Will Help Pay For Replacement Veneers

    Veneers can fix a wide range of cosmetic issues, but cannot repair damaged teeth. Dental veneers to add life to your smile dental veneers there are two types of dental veneers that we utilize at our office in abington, pa.does dental insurance cover composite veneers. Since insurance companies think of dental veneers as cosmetic, they dont usually cover veneers.

    Does Dental Insurance Cover Crowns

    What Does Dental Insurance Typically Cover

    Having a crown put on, either on a broken tooth after a root canal or put on an implant, is the most common dental procedure in the country. Dental insurance usually wont cover the entire cost of a crown. In many cases, crowns are considered a major dental service and many dental insurance plans cover 50% after a waiting period. If you suspect that youre going to need a crown when you are buying dental insurance look for a plan that offers some coverage for major dental procedures.

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    Is Dental Insurance For Implants Different From Full Dental Coverage

    The short answer here is no. Dental insurance plans vary based on their state and the type of treatments they cover. Full coverage plans mean they cover preventive care, like cleanings, fluoride treatments, and X-rays basic care, like fillings and extractions and major services, like bridges, crowns, dentures, and dental implants, among other treatments.

    The plan might cover bridges, crowns, and dentures but not dental implants and still qualify as full dental coverage. Here is another way to think of it: All dental insurance plans for implants will be full coverage, but all full dental coverage plans will not cover dental implants.

    How Much Would Veneers Cost

    Well, the answer to that is, first, how many do you need? Because, yes, the rumors are true that veneers can be quite expensive, especially the ones made in porcelain. A traditional veneer can cost around $900 to $2500 per tooth, but this can last you 15 years. Some also offer cheaper veneer type for $800 to $2000 but this would only last you less than 10 years. With the cost considered, some patients opt to use one or two veneers only, just to target the severely damaged teeth. However, to fully appreciate the magic that veneers can do to your smile, dentists recommend getting six to eight veneers that typically covers the upper front teeth so you can have an even brighter smile with even, straighter, and whiter teeth.

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    Tips To Help You Understand Your Dental Insurance

    You may not realize it, but dental insurance is completely different than medical insurance. Because people use their medical insurance more, they may get confused about the differences. We meet with so many patients who are not in touch with what their dental plan actually covers, so we wanted to share some important information and tips to keep you informed about your coverage and its use. Please note that the information were providing does not apply to HMO/DMO plans.

    With most medical insurance plans there is no real maximum spend. You may have to pay $4,000 out of pocket to get your deductible met before insurance starts paying, but there most likely will not be a cap on the coverage for the year.

    However in dentistry, while the deductibles may be smaller at $50-$100, the maximums are much lower. For care that goes beyond the routine, most plans cap coverage at $1,500 a year, although higher annual limits can be arranged by paying a higher premium.

    Because dental insurance coverage differs so greatly from medical insurance, it is more appropriate to call it a dental benefit. Dental insurance acts as more of a gift card to put towards your treatments. Once the dollar amount is reached, the gift card has run out.

    Here are 4 tips to help you understand your dental insurance:

    What Is A Participating Dentist

    A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services. Negotiated fees typically range from 30 – 45% less than the average charges in a dentists community for similar services.2 Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefit maximums. Negotiated fees are subject to change.

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    What Is Delta Dental

    Delta Dental is one of the biggest dental insurance providers in the United States. They offer a variety of insurance plans, catering to different needs at a good value.

    There are three main categories of insurance plans offered by Delta Dental:

  • Individuals and families
  • Small Businesses
  • Retirees
  • There are several more options to choose from within these categories. For example, there are five different plans within the individuals and families category.

    Delta Dental coverage is also offered, to some degree, in all 50 states in the U.S.

    If you use Dental Dental, theres a good chance your orthodontic treatment will be covered. However, this depends on your plan and the type of treatment needed.

    You can get enrolled in a suitable Delta Dental plan through your employer or by buying an individual plan.