Dental Insurance: What does it cover?

Dental insurance often comes in the form of “100-80-50.” This means that the insurance provider pays for 100 percent of the cost of preventive care (such as cleanings and routine checkups), 80 percent of the cost of basic procedures (such as fillings or root canals), and 50 percent of the cost of more advanced procedures (such as bridges or crowns).

What Dental Insurance Covers

Dental insurance can go a long way in helping to pay for a number of services that range from basic care to advanced surgical procedures.

As evidenced by the 100-80-50 model, the more advanced the procedure, the less coverage you might expect to receive from your dental insurance plan.

These services, in order from the most basic of care (widely covered by dental insurance) to the more advanced (not as widely covered) include:

Preventive care. Routine dental exams and cleanings typically take place every six months and are covered in full by most dental insurance policies.

Restorative care. Restorative care consists of any minor procedures to treat damaged or decayed teeth, such as fillings.

Endodontics. More advanced damage or decay will require more involved procedures like root canals.

Oral surgery. Common oral surgeries include teeth removal, the drainage of infections, and gum tissue biopsies.

Orthodontics. This includes the installation, maintenance, and removal of braces and retainers.

Periodontics. Periodontics involves the treatment of gum disease, infections, and lesions.

Prosthodontics. Fittings and installations of dentures and bridges can be expensive, and you will need a quality insurance policy to help alleviate this cost.

The Cost of Not Having Dental Insurance

Many people avoid the dentist simply because they don’t like going. Others stay away because they don’t enjoy the cost. In fact, according to the U.S. Department of Health and Human Services, almost 108 million Americans do not have dental insurance,

But the ones that do will incur many of the same out-of-pocket expenses as regular health insurance, including premiumsdeductibles, and copayments or coinsurance.

While this may seem like a burden, it can pale in comparison to the cost of some dental care services without insurance.

Listed below are some average shelf prices for common dental services.

  1. Exams (including x-rays and cleaning) = $288
  2. Fillings (single, silver-amalgam filling) =  $50 to $150
  3. Tooth extractions (non-surgical, gum-erupted) = $75 to $300
  4. Crowns (single resin) = $328
  5. Root canals (single, exposed) = $120

Dental insurance can often be a confusing industry as it is not as heavily regulated as the health insurance industry. Also, often dental offices will have their own internal version of insurance on a monthly schedule by paying their office directly.

Dental Insurance in the Workplace

Under the Affordable Care Act, companies with at least 50 employees are required to provide group health insurance for their employees or face a penalty. However, vision and dental insurance are not required as part of this mandate. 

As a result, dental insurance benefits granted by an employer-sponsored plan are the exception, not the rule. In fact, only 53 percent of companies that offered health insurance in 2014 provided any sort of dental benefits.

Meanwhile, from Phoenix’s experience, the two most popular voluntary benefit programs for employees are vision and dental insurance.

Dental Insurance for Children

While vision and dental insurance for adults is not a requirement of the Affordable Care Act, dental benefits for children is a required benefit offer under all plans that qualify as “minimum essential coverage.”

This means that all children under the age of 19 enrolled in individual, family, and small group health insurance plans must be offered basic and preventive care for vision.

If this all seems complicated, a licensed insurance agent can help you understand the options that are best for you and your family. Our Phoenix Captive Solutions staff are always more than willing to help.

This article was written by Phoenix Captive Solutions C.F.O. Blake Coats, any views or opinions do not necessarily reflect the opinions of either Phoenix Captive Solutions LLC, or any associated entities.  

Feel free to write to Blake at  

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