What Dental Insurance Doesn't Cover
Dental insurance doesn’t always cover all procedures. And the fine print isn’t always helpful when selecting a plan for yourself or your family. Since you can’t afford to ignore your dental health, you need to understand what dental insurance covers and doesn’t.
Get to know what dental insurance covers and doesn’t, how it works, and how to get affordable dental care with or without insurance.
How Does Dental Insurance Really Work?
Insurance companies design dental insurance plans to support your dental care needs financially. There are different types of dental insurance plans available for you.
Preferred Provider Organizations
PPOs, or Preferred Provider Organizations, are popular dental insurance providers and offer flexibility to patients. They allow you to see any dentist you choose, whether in or out of their network.
However, PPOs offer greater discounts and reduced out-of-pocket expenses when patients visit dentists who are part of the PPO's network. This means you can save money by staying in-network but still have the freedom to choose your own dentist.
Advantages
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More flexible – patients can see any dentist, in or out of the network.
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Greater discounts and reduced out-of-pocket expenses when patients visit in-network dentists
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You don’t need a referral to visit a specialist.
Disadvantages
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Higher premiums and deductibles compared to HMOs.
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Out-of-network services are more expensive.
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Patients may need to file claims and wait for reimbursement.
Health Maintenance Organizations
HMOs or Health Maintenance Organizations are another type of dental insurance provider. HMOs typically require choosing a primary care dentist from a network of providers. You must visit your primary care dentist for all dental needs and get referrals to specialists, if necessary.
HMOs offer lower cost savings since they focus on preventive care and provide little coverage for major dental procedures.
Advantages
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Lower premiums and deductibles compared to PPOs.
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Focus on preventative care to reduce dental problems.
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Little or no out-of-pocket expenses for preventative services.
Disadvantages
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Limited provider network, with patients required to choose a primary care dentist
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You’ll need a referral for specialist visits.
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Little or no coverage for major dental procedures
Indemnity Plans
Indemnity plans, or traditional dental insurance plans, offer the most flexibility. These plans allow you to see any dentist and provide a set fee schedule for dental procedures.
With this type of dental insurance plan, you’ll be responsible for paying the difference between the fee schedule and the actual cost of the procedure. Indemnity plans are often more expensive than PPOs or HMOs but offer greater flexibility.
Advantages
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Most flexible - you can see any dentist you choose.
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Fixed fee schedule for dental procedures
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Greater choice and control over your dental care.
Disadvantages
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Highest premiums and deductibles compared to PPOs and HMOs.
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You’re responsible for paying the difference between the fee schedule and the actual cost of procedures.
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You may need to file claims and wait for reimbursement.
Medicare Advantage
Some Medicare Advantage plans offer dental benefits. However, you may need to pay higher premiums and know your maximum benefit. You'll have to pay dental bills out of pocket if you exhaust your maximum coverage benefit before the year ends.
What Dental Insurance Doesn’t Cover
There are certain services that dental insurance plans may not or may only partially cover. They include the following.
Cosmetic Procedures
Dental insurance plans don’t cover cosmetic dental procedures like teeth whitening, veneers, or orthodontic treatment for purely aesthetic reasons. Many insurance companies consider cosmetic procedures to be medically unnecessary. So, if you want to whiten your teeth for a brighter smile, you’ll have to pay for the procedure out of pocket.
Pre-existing Conditions
Some dental insurance plans may not cover pre-existing conditions. Others may have a waiting period, called an exclusion period, before coverage begins for specific dental care needs.
If you have a missing tooth before enrolling in a dental insurance plan, for example, you may have to wait for a certain period before getting coverage for a dental implant.
Experimental Treatments
Dental insurance plans don’t cover experimental treatments that the dental community hasn’t widely accepted.
For instance, if dentists don’t widely accept a new treatment for gum disease, your dental insurance may not cover the cost of the treatment.
High-cost Procedures
Some dental insurance plans may only cover a portion of the cost of high-cost procedures. Good examples of these procedures are dental implants, crowns, or bridges. If you need a dental implant, you may have to pay a significant amount out of pocket, even if you have dental insurance.
Payment Options for Dental Care
If you don't have insurance coverage for a dental procedure, you can still explore alternative payment options to help manage the costs. Here are some options:
Dental Savings Plans
These programs offer discounts on dental procedures at participating dentists. You’d typically pay a monthly or annual fee and receive discounted rates on most procedures.
Payment Plans
Many dentists offer payment plans to help spread out the cost of treatment. You can speak to your dentist about setting up a payment plan that works for you.
Health Savings Accounts (HSA)
HSA lets you save part of your income pre-tax for qualified medical expenses. If you have an HSA, you can use the funds to pay for dental procedures not covered by insurance.
Credit Cards
Some dentists may accept credit cards to help you pay for dental treatment over time.
Personal Loans
You can also consider taking out a personal loan to cover the cost of dental treatment. However, carefully review the terms and interest rates before taking out a loan.
Charity Organizations
There are also charity organizations that offer assistance with dental care costs. However, it's important to note that if you're experiencing a dental emergency and cannot pay for treatment, relying on a charity organization may be unwise as the process usually takes a while. Seek care immediately. Many dental offices offer emergency care and can work with you to arrange a payment plan or other financial assistance.
What Does Dental Care Cover? Or What are the main categories of dental coverage?
Dental insurance typically covers a wide range of dental services. This includes the following:
Preventive Care Services
Preventive care services are usually fully covered by dental insurance. These services include:
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Cleanings
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X-rays
These services are crucial for maintaining good oral health and preventing more serious dental problems from developing.
Restorative Procedures
Restorative procedures are also typically covered by dental insurance. Although, coverage may vary depending on the specific plan. Examples are:
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Crowns
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Root canals
These procedures help to repair damaged or decayed teeth and restore their proper function and appearance.
Emergency Treatments
In addition to preventive and restorative care, dental insurance may also cover emergency treatments. Tooth extractions or treatment for a dental abscess are examples of emergency treatments.
Dental insurance often covers these services to ensure that you receive prompt care during a dental emergency.
Save on Dental Care Today!
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With a Carefree Dental card, you can save between 15% and 50%* per visit in most instances, on checkups and other procedures at participating providers.
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*Actual costs and savings vary by provider, service, and geographical area.
The Carefree Dental blog is not meant to be a substitute for professional medical advice, diagnosis, or treatment. The text and pictures within the content are intended for information purposes only. Readers should consult with a licensed dentist or healthcare professional before seeking treatment.
The Carefree Dental Card is not insurance, and Carefree Dental is not an insurance provider.
