dental cost insurance plans typically have a deductible that must be paid before the plan starts paying. Some also have copays, which are set dollar amounts.
More than three in four Medicare Advantage enrollees offered more extensive dental benefits are in plans with annual maximum dollar caps on their dental coverage.
Preventive Care
Some dental insurance plans include no copayments for preventive care like twice-yearly cleanings and x-rays. These services help to catch problems early on and reduce the risk of more expensive procedures down the road. However, most dental plans come with deductibles and annual maximums, which are the max amounts that the insurance company will pay for your treatment in a year or lifetime.
Some plans require you to pay a copayment, typically a low amount like $20, for visits and treatments. Others have a deductible, which is similar to that of medical insurance and often applies to non-preventive treatments. DPPO (dental preferred provider organization) and DHMO (dentist health maintenance organizations) are types of dental insurance that offer the lowest premiums, but only cover in-network care. They also usually have a referral requirement for specialist visits.
Routine Cleanings
Even with the best brushing and flossing techniques, teeth still accumulate plaque and tartar. Routine cleanings are necessary twice a year to remove this and reduce the risk of gum disease and tooth decay. Cleanings also serve a diagnostic purpose, as the dentist can see areas of concern and recommend other services.
Most dental insurance plans cover the cost of routine cleanings and oral exams. However, they may require you to meet a deductible before coverage kicks in.
A standard cleaning from a dental hygienist typically costs between $125 and $170, depending on whether you have insurance or not. This procedure can take up to an hour, but if you have gum disease or excessive plaque build-up the dentist might need to do a more involved treatment called debridement and scaling, which would increase the cost.
X-Rays
Dental X-rays are an important part of dental checkups, helping to detect tooth decay and other problems early, often saving money and mouth pain in the future. X-rays emit very small amounts of radiation, which is less than what you’d experience during a plane ride or even a day at the beach. The biggest contraindication to radiography is pregnancy, but protection in the form of a heavy-duty lead apron can be provided.
The cost of X-rays can vary depending on the type and number required, as well as your insurance coverage. Ask your dental professional to provide a quote that best reflects your situation. Most dental plans have frequency limitations and coverage levels for different types of X-rays, so be sure to verify the details with your insurer.
Fillings
Dental fillings restore teeth that have cavities and decay. They are generally covered by dental insurance once you meet your deductible and annual maximum.
Choosing the right filling material can dramatically affect the cost of your treatment. Silver amalgam, composite resin and porcelain are among the most common materials. Amalgam fillings are inexpensive and highly resistant to wear, while composites are more expensive but look more natural. Porcelain inlays, also known as onlays, are more costly than silver but are stain-resistant and durable.
Many dental insurance plans have coinsurance instead of a deductible. This means you pay a set percentage of the cost of your care after reaching your annual maximum. Other types of plans include copays, which are flat fees you must pay at the dentist.
Crowns
Known as “caps” to many, crowns are tooth-shaped covers designed to encase and protect a damaged or weak tooth. They are used for a wide variety of reasons, including reshaping a discolored or broken tooth, holding in a dental bridge or covering a root canal-treated tooth.
Crowns are available in a range of materials. Some offer better cosmetic appearances and others are stronger to withstand heavy biting forces. Porcelain and porcelain fused to metal crowns are commonly used. More recent options include all-ceramic crowns (such as E -Max) and zirconia, which are light, thin and durable.
Maintaining good oral hygiene habits and seeing the dentist consistently for teeth cleanings, X-rays and fluoride treatments can help promote the lifespan of crowns and other dental work. Additionally, wearing a mouth guard at night can help prevent clenching and grinding, which can damage or chip a crown.
Bridges
Dental bridges fill in gaps left by missing teeth. They’re an option for patients who don’t want implants or who can’t get them due to health or other concerns.
Missing teeth can lead to serious oral health problems if not treated immediately, including jaw instability, changes in the shape of your face, gum disease and problems chewing and speaking. They can also cause adjacent teeth to shift, which can affect the health of those teeth as well as your bite and appearance.
A traditional bridge is comprised of dental crowns that are cemented onto the healthy adjacent teeth called abutment teeth. A cantilever bridge affixes to only one adjacent tooth, while a resin-bonded or Maryland bridge adds a metal or porcelain support to the back of the abutment teeth.
Implants
Dental implants are the most effective and longest-lasting replacement for missing teeth. However, they cost more than other tooth-replacement options like dentures or dental bridges.
Generally, dental insurance doesn’t cover the full price of an implant. However, some plans may cover the costs associated with a bone graft, sedation and other procedures required to prepare for the implant.
Some organizations, such as the Dental Lifeline Network and Give Back a Smile, offer grants that help with the cost of dental implants for people who are medically or socially fragile. Patients who need an implant due to gum disease or traumatic injury should consult with a dentist to see if they qualify for coverage. The process usually involves taking X-rays, a CT scan and a gum and bone evaluation.
