What Does Dentist Insurance Cover? Things to Expect


What does dentist insurance cover? This is important because a dental plan does not really function like a typical health insurance. The basics are the same, of course, but there are also some intrinsic differences.

For instance, a dental insurance covers pre-existing coverage; your usual health insurance does not. However, some plans may restrict or limit coverage for users or plan holders with missing teeth.

A dental insurance also has a waiting time — or the period of the time you need to have been using the plan before you can avail of more expensive or extensive procedures.

Essentially, what does dentist insurance cover are the basics and the essentials. No dental insurance covers everything. But what should you expect?

Plans usually have a “100-80-50” coverage. This means it covers 100 percent of the cost of preventive procedures, 80 percent of the cost of basic procedures, and 50 percent of the cost of major procedures.

Preventive procedures include check-ups, sealants, and teeth cleaning.

Basic procedures include fillings and root canals.

Meanwhile, major procedures include more expensive treatments such as application of crowns and bridges.

It’s important to note what the insurance does not cover as well. Cosmetic procedures are not included in a typical dental plan; this includes gum contouring and teeth shaping, among others.

Dentures and braces are also not included in usual dental plans; in fact, procedures pertaining to this may also not be covered as well. You need to check with your insurer if these will be covered. Otherwise, it is advisable to look for other plans — or considering getting a plan specifically for these conditions.

You need to check with your provider to know specifically what does dentist insurance cover. Plans normally include diagnostic and preventive procedures, but will it cover emergency procedures as well?

Some plans also offer comprehensive coverage or premium policy; the specifics of these vary on a case-to-case basis. This can be cost effective, especially if you think you will need extensive care for your teeth. But this will cost you more; as with any type of insurance, the more comprehensive the coverage the more expensive it is. Before choosing this option, thoroughly check if you will indeed need all the procedures covered in the plan. Otherwise, you will wasting money on a plan you will hardly use.

The waiting period is also a major consideration when checking what to expect from your dental insurance.

Majority of plans has this; what you should look into is how long the waiting period is (and if this is reasonable for you and justifiable considering the cost of the plan) and what procedures are available to you when you are still locked into the said waiting period.

Normally, during the waiting period, only basic and major procedures will be restricted. This means you should be able to avail simple procedures like check-ups and cleaning. If the plan restricts this well during the waiting period, then you should shop for other providers. The waiting time is usually from six months to one year.

Checking what your dental plan covers will definitely ensure that you are spending your money wisely — and making your teeth healthier in the process.

What does dentist insurance cover? It goes beyond tooth ache, definitely. Find out the A-Z and all the ins and outs of dentist insurance at