Dental Insurance - What Is Covered, What Isn't Covered
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What Does Dental Insurance Cover?
Dental insurance reduces the cost of dental care and helps patients maintain good oral health throughout life. Insurance allows patients to spend less “out of pocket” and catch signs of oral diseases early.
Most dental plans cover some portion of preventive treatments, restorative procedures, and orthodontic treatment.
According to CIGNA’s website, many insurance companies use the “100-80-50” plan, which covers:
- 100 percent of regular preventive care, such as teeth cleanings, dental exams, and fluoride treatment.
- 80 percent of basic procedures, such as dental fillings, extractions, and root canals.
- 50 percent of major procedures, such as bridges, implants, and crowns.
What Does Dental Insurance Not Cover?
Dental insurance does not cover cosmetic dental procedures, also known as esthetic dentistry. Cosmetic procedures are never covered by insurance because they are not considered “medically necessary.” Esthetic procedures include teeth whitening and veneers. Both of these treatments improve a patient’s appearance, rather than restore damaged teeth.
The most common age groups that undergo cosmetic dental procedures are patients between 31 to 40 years old (38 percent) and 41 to 50 years old (32 percent).
Insurance Terms to Know
Deductibles
The deductible is the out-of-pocket costs patients pay before treatment. Insurance providers pay for part or all of the expenses after treatment, and patients get reimbursed.
Copayment
A copayment, also called a “copay,” is the shared amount a patient pays for treatment. This amount is usually a percentage of the dentist’s fee.
Dual Coverage
Dual coverage means more than one dental insurance plan covers the patient’s treatment.
Treatment Limitations
Depending on your insurance plan, procedures can only be completed a certain amount of times per year. For example, most insurance companies typically only cover oral exams twice per year (every six months). So, if more exams are necessary, insurance will not cover them. Also, some policies do not cover pre-existing dental conditions, such as missing teeth that were lost or damaged prior to receiving insurance.
Dental Coverage: Preventive Care
Preventive dental care is covered 100 percent by most insurance plans (after deductible). For example, common treatments include:
Dental Exams
During oral exams, dentists examine the mouth for signs of cavities, gum disease, and other related conditions.
Routine Teeth Cleanings (twice a year)
During teeth cleanings, a dentist removes hard-to-reach plaque and calculus from the surfaces of teeth and between teeth.
Dental X-rays (once a year)
X-rays aid in the diagnosis of oral diseases that are not visible during a normal dental exam.
Fluoride Treatment (in-office)
Fluoride is a mineral that helps prevent tooth decay and strengthens enamel. Small traces of fluoride are in tap water, toothpaste, mouthwashes, and professional dental materials.
Tooth Sealants
Sealants are thin coatings that form “physical barriers” on the pits and fissures of teeth that help prevent cavity formation early on. However, this treatment is typically only effective in protecting a child's teeth against cavities, not an adult.
Dental Coverage: Basic Services
With standard policies, insurance covers minor restorative dental procedures (80 percent covered after deductible). For example, these procedures include:
Cavity Fillings
Dental fillings are used to fill minor dental cavities (decaying teeth).
Emergency X-rays
Any additional X-rays (more than twice a year) are not fully covered by insurance.
Emergency Dental Care
Mouth injuries resulting in knocked out, fractured, or damaged teeth.
Tooth Extractions
Teeth that need to be removed due to severe decay, injury, or disease (non-surgical).
Dental Coverage: Major Services
With standard policies, insurance only partially covers invasive restorative procedures (50 percent covered after deductible). In particular, these procedures include:
Root Canal Treatment
Root canal therapy restores infected dental pulp in the roots of teeth and also relieves dental pain.
Scaling and Root Planing
Scaling and root planing involves the removal of plaque and calculus (hardened plaque) above and below the gumline.
Dental Crowns
Crowns are placed over chipped, broken, or damaged teeth. They protect weak teeth, typically caused by severe decay.
Dental Inlays and Onlays
Inlays and onlays are indirect restorations, which means they are made outside of the mouth in a dental laboratory. They are typically used when a patient’s cavity is too large for a filling.
Dental Bridges
A dental bridge is a fixed restoration that replaces one or more missing teeth in a patient’s dental arch.
Dentures
Dentures are artificial substitutes that replace some or all of a patient’s natural teeth and surrounding tissues.
Dental Restoration Repairs
Repairs are covered by most insurance plans if they are needed more than 12 months after placement.
Oral Surgery
Many oral surgeries are covered by insurance. Surgical tooth extractions, such as impacted wisdom teeth removal, are also covered.
Dental Anesthesia
A safe drug that alleviates pain and discomfort during a dental procedure.
Popular Dental Insurance Providers
Cigna
CIGNA is a common dental insurance provider. There are three types of plans to choose from, depending on the patient’s needs and how many family members they have.
Cigna Dental Preventive (Lowest)
The lowest plan starts at $19 a month per person and covers 100 percent of preventive services. Restorative services and orthodontics are not covered. This plan does not include a deductible.
Cigna Quality Provider Network Dental Coverage (Cigna Dental 1000)
The middle plan starts at $30 a month per person and covers 100 percent of preventive services. Deductibles range from $50 (individual) to $150 (families). Restorative services are covered up to $1,000 per year (after deductible and coinsurance). This plan does not cover orthodontic treatment.
Cigna Highest Level of Dental Coverage (Cigna Dental 1500)
The highest plan starts at $35 a month per person and covers 100 percent of preventive services. Deductibles range from $50 (individual) to $150 (families). Restorative services are covered up to $1,500 per year (after deductible and coinsurance). Lastly, orthodontic treatment is covered up to $1,000 (lifetime limit). Orthodontic insurance has a separate coinsurance and deductible.
Other popular providers with similar dental insurance plans include:
Dental Insurance FAQs
Is there a dental insurance that covers everything?
Dental insurance plans that cover mostly “everything” are called fee-for-service dental insurance or indemnity. These plans typically cost double the amount of regular dental insurance ($780 a year vs. $350 a year).
Is it worth paying for dental insurance?
If you only need teeth cleanings, x-rays, and regular check-ups, you may end up losing money with dental insurance. However, if you need restorative dental work, insurance can save you hundreds or thousands of dollars on treatment.
Is there dental insurance for cosmetic dentistry?
Most cosmetic dental procedures are elective, which means they aren’t covered by insurance. Medically necessary cosmetic procedures, however, are partially covered by insurance.
Resources
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
Individual CIGNA Dental Choice. https://www.cigna.com/assets/docs/texas/844097_Dental_Choice.pdf
“What Dental Insurance Covers.” Https://Www.deltadental.com, https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/dental-insurance/what-does-my-dental-insurance-cover.html.
We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
