Dental insurance can help you and your family more easily afford the services needed to keep your smiles healthy. But how does dental insurance work? Though no two dental insurances are exactly the same, most work in generally the same manner.
Dental insurances have a deductible, which is a minimum amount that is paid out of pocket before the insurance reduces costs. For example, if the deductible is $100, the patient first pays $100 towards their treatment before dental insurance kicks in and pays any additional costs.
Keep in mind that most insurances have a co-pay. This means that after the deductible is met, dental insurance will pay part of the remaining bill and the patient is responsible for the rest of the treatment cost. The patient’s portion of the final bill is referred to as the co-pay.
Most dental insurance companies have a yearly maximum, or a maximum amount of coverage per year. Typically, maximums range from $750 to $2000 per year. Once the patient reaches the maximum, they are responsible for all of the remaining charges for the year.
Preventive, Basic, and Major Procedures
Typically, dental insurances group dental procedures into three categories of coverage: preventive, basic, and major. Most dental insurances cover 100% of preventive care, including dental cleanings, X-rays, and sealants. Basic treatments include things like gum disease treatment, extractions, and dental fillings. Dental insurances usually cover 70 to 80% of these treatments. Major treatments include procedures like dental crowns, dental bridges, and dentures. Major treatments are usually only covered at a high co-payment, so the patient pays more out of pocket for these procedures. Be aware that insurances differ in how they categorize procedures into these three categories.
The majority of dental insurance policies do not cover any costs for cosmetic procedures. These include teeth whitening, tooth shaping, gum contouring, and veneers. As these procedures are meant to improve the look of the teeth, they are not deemed as medically necessary.
We encourage you to contact Smiles Unlimited today with any questions about dental insurance and to schedule your next visit with Dr. Rakhi Jani. Our dentist and team in Livermore, California, are excited to serve you and your smile!