Many health insurance plans exclude dental care

Although many health insurance plans exclude dental care, some plans may cover routine office visits or orthodontia (straightening of the teeth). When a plan doesn’t cover dental care, it may offer an option to buy separate dental insurance to add to your health insurance policy. Dental insurance plans may use a network of dental care providers, similar to health care networks.

To control costs, a dental insurance plan may impose a dollar limit (cap) on the amount of benefits the plan pays. Plans may also restrict or even exclude the number and/or types of services that are covered to keep costs down.

Dental care coverage varies and may include the following:

1. Crowns and bridges
2. Endodontics (root tips, nerves)
3. Oral surgery, periodontics (gums, bone)
4. Orthodontia (braces)
5. Prosthetics (bridges, dentures, partials)
6. Restorative services, such as fillings
7. Routine diagnostic and preventive services, such as examinations, X rays, and cleaning

If you use dentists within a network of dental care providers, you may receive full coverage for routine exams and cleanings, and you may pay lower prices for other treatments. Dental networks usually require you to file a claim. Another way to control costs is with a dental discount card program, which is often offered in conjunction with but separately from your health insurance plan. Dentists who participate in a dental discount card network provide discounts on several of the most common dental services such as examinations, fillings, and gum treatments. If you’re a member of a dental discount card program, just show your card each time you visit the dentist.

Cleaning and X rays

Dentists use prophylaxis (teeth cleaning) and X rays to diagnose oral health conditions. Dental insurance plans may cover only a limited number of these services per year. If you choose a dental insurance plan that uses deductibles and coinsurance (as opposed to the discounts that a dental discount card program provides), look for a plan that covers diagnostic and preventive services.

Routine restorative care

Routine restorative care is a fancy way to refer to dental fillings. Check to see what types of services your plan considers routine restorative care and what benefits the plan pays for these services.

Oral surgery and orthodontia

Oral surgery embodies a variety of procedures, including the following:

• Endodontics (treating root canals for diseases of the pulp and bone, removing tooth nerves, bleaching discolored teeth, managing traumatic injuries to the teeth, and performing related surgery to help preserve the natural teeth in a healthy state)
• Periodontics (treating complicated periodontal disease involving bone grafts or underlying tissues)
• Placing or restoring dental implants
• Removing impacted teeth, tissue biopsy, and draining minor oral infections

Because many dental insurance plans emphasize and encourage preventive care, some plans may pay only 50 percent of expenses for oral surgery. Other plans, may pay 80 to 100 percent. Examine your plan in detail to learn what the oral surgery benefits are.

Orthodontia involves straightening teeth and treating problems related to the growth and development of the jaws. The sample plans cover orthodontia at 50 percent, with no deductible, and impose a $1,000 lifetime maximum. Treatments for temporomandibular joint (TMJ) syndrome, which affects the joints at the jaw, is usually covered under medical, rather than dental, insurance. Your dental insurance plan may pay benefits for oral surgery and/or orthodontia procedures based on reasonable and customary fees.

Some insurers may write plans to include a separate deductible for dental care and an annual maximum on payments. You may have a waiting period after the policy takes effect for some major dental procedures. If your plan has a provision that sets an annual maximum benefit for dental care, think about dividing up and receiving treatment over several years, if feasible. Watch for lifetime maximums on certain types of dental care, such as orthodontia.