Most dental insurance plans expire at the end of the calendar year, with benefits restarting on January 1. Therefore, as the conclusion of 2022 draws nearer, you might be wondering how you can maximize your current plan before it is gone forever. To help you out, we have put together a basic guide on what dental insurance typically covers. It will help you start planning to use your policy in the most beneficial way!
Preventive Care
Dental insurance companies recognize that preventive care helps patients establish the foundation for long-lasting oral health. That is why services like checkups, cleanings, and routine X-Rays are usually 100% covered. (Typically, up to two exams and cleanings are covered in a calendar year.) Often, you do not even have to pay a deductible before you can use your plan to cover basic preventive care.
Minor Restorative Care
After you take care of your plan’s deductible, your minor restorative care may be 70 – 80% covered. Insurance companies can vary in what they class as “minor” services, so you will have to check your specific policy to see how it applies to various treatments. In general, though, things like fillings, simple extractions, and nonsurgical gum disease therapy fall into this category. In some cases, root canal therapy is included as well.
Major Restorative Care
Major restorative care is usually 40 – 50% covered, up to the amount of a plan’s annual maximum. An annual maximum is the highest amount that your insurance company is willing to pay out within a calendar year. In many cases, the cost of a major procedure will exceed a plan’s maximum. To keep your out-of-pocket costs as low as possible, it may be wise to schedule part of your treatment in 2022 and the rest in 2023. This can enable you to utilize two annual maximums instead of just one.
What exactly does “major restorative care” include? Again, this can vary between policies. However, things like surgical tooth extractions, crowns, bridges, and dentures usually fit into this category.
What Is Not Covered?
It is standard for dental insurance plans to exclude coverage for purely elective and cosmetic services, such as veneers and teeth whitening. Orthodontia is also not covered by most plans. Dental implants may be another excluded service. However, because implants are widely recognized as the best form of tooth replacement, many insurance companies are beginning to class them as a major restorative treatment.
If you are interested in undergoing any service that your benefits do not cover, ask your dentist in Pittsburgh about alternative payment options, such as financing.
Every dental insurance plan is unique. However, the above information can give you a general idea of what to expect as you endeavor to maximize your benefits.
Meet the Practice
Drs. Joyce and John Warwick are a husband-and-wife pair of dentists with many decades of combined experience. They and our team respect patients’ budgets and are pleased to accept payment from both in-network and out of network insurance policies. To learn more about us and how we may be able to serve you, contact us at 412-391-1130.