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Determining Your Benefits: What Does Your Dental Insurance Cover?

November 28, 2023

Filed under: Uncategorized — sandberg @ 8:22 pm
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Dental insurance can be complicated to navigate and even more difficult to understand, which is why having a dental team that is happy to help you get the most out of your benefits is so important! Additionally, because every insurance plan is different, it can be hard to nail down what services yours will and won’t cover. Read on to learn more about dental insurance and how to learn what treatments may be covered.

How Do Dental Insurance Plans Determine Coverage?

Every dental insurance plan is different, and depending on what type of coverage you elect, the treatments that your provider will pay for can vary. That being said, most dental insurance plans use a 100-80-50 structure. This means that they will cover 100 percent of the cost of preventive services, like checkups, cleanings, and X-rays, 80 percent of more basic treatments, like cavity fillings, and 50 percent of more extensive procedures, like dentures, root canals, etc.

If you’re planning on getting a certain treatment, like dentures, it’s best to contact your dentist’s office directly to see if they can pre-authorize the claim with your insurance to determine how much you’ll need to pay out-of-pocket. Or, if you would prefer, you can reach out to your insurance company directly.

Here’s some of the treatments that your policy will most likely cover at least a portion of the cost of:

  • Crown or bridges
  • Tooth extractions
  • Cavity fillings
  • Checkups and cleanings
  • X-rays
  • Root canals
  • Emergency procedures, like oral surgery

Getting the Most Out of Your Benefits

There are two primary ways you can maximize your dental insurance benefits:

  1. Take Advantage of Your Preventive Coverage: The best way to prevent worsening oral health problems is to prevent them from being able to progress in the first place. By attending your routine checkups and cleanings, which are typically 100 percent covered by dental insurance, you can stay on top of your dental hygiene and avoid serious oral health concerns.
  2. Reach Your Annual Maximum: Most dental insurance plans renew at the beginning of the new year, on January 1st. It’s on this day that your fees and premium may change, and your maximum will reset. To get the most out of your investment, it’s best to get all of the treatments you need up to the maximized amount allowed by your insurance company before your plan resets and while your deductible is already paid.

Although complex to navigate, dental insurance can help you save hundreds if not thousands of dollars every year, making it well worthwhile. Plus, with a helpful and competent dental team by your side, getting the most out of your benefits will be much easier.

About the Practice

At South Jersey Center for Dental Medicine, our team is led by two highly experienced and compassionate dentists, Dr. Joseph Sandberg and Dr. Vidya Kini Kukkundur. With their combined experience, along with a best-trained dental staff, our team is able to provide top-notch dental care that’s accessible. We not only participate with Delta Dental Premier, but we’re happy to accept and file for all out-of-network dental plans as well. For questions or to schedule an appointment, visit our website or call 856-596-4333.

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