Dental coverage varies depending on the complexity of the procedures you require. All insurance companies split dental care into three distinct categories:
- Preventative: Routine hygiene and monitoring services like cleanings, X-rays, and exams
- Basic: Minor restorative procedures like fillings and extractions
- Major: Involved and lengthy procedures like crowns and bridges
When purchasing a dental policy, you can choose your desired coverage level. Basic dental plans cover most preventative care and certain restorative procedures like fillings and extractions. Though more expensive, comprehensive policies pay for many of the same services and major dental procedures like root canals, dentures, braces, or implants.
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Exploring Dental Care
Insurers compare dental procedures’ complexity and overall cost to determine whether they count as preventative, basic, or major care.
Dentists practice preventative care to maintain and monitor their patients’ oral health and wellness. These services range from cleanings to X-rays and mouthguards, all employed to identify, prevent, or treat problems early on. Routine preventive care helps ensure that minor issues do not develop into conditions requiring more involved and costlier treatment, saving patients time, money, and distress.
What Does It Cover?
Many insurance policies cover preventative care for little or no copayment. Services commonly classified under this umbrella include:
- Exams to check for cavities, gum disease, plaque, and other signs of decay
- X-rays to monitor the general health of your teeth, roots, and jawbone
- Deep cleanings to remove built-up plaque and tartar that could otherwise lead to cavities and gum disease
- Athletic or nighttime mouth guards to protect teeth from impact or grinding
- Fluoride treatments that strengthen tooth enamel to reduce the risk of cavities and decay
- Tooth sealants to protect the chewing surface of teeth from germs and food
- Space maintainers to ensure children develop a healthy bite
Whereas preventative services stop potential problems before they arise, basic care addresses existing issues like cavities and minor gum disease. Procedures categorized as basic typically include straightforward restorative techniques that do not require anesthesia or surgery. While benefits vary from plan to plan, most patients must contribute a modest copayment for covered basic services.
What Does It Cover?
Most insurers categorize the following procedures as basic dental services:
- Amalgam or composite fillings to treat cavities
- Root canals to remove infected pulp and nerves inside teeth
- A temporary sedative filling to stabilize a tooth before a root canal
- Periodontal scaling and root planning to remove tartar, smooth root surfaces, and remove infected tooth structure
- Extraction of impacted, decayed, or overcrowded teeth
- Dental crowns that protect weak or broken teeth
- Reattachment of loose crowns
- Non-routine X-rays that examine known issues and help dentists determine a treatment plan
- Periodontal surgery to restore function to teeth, gums, and bone damaged from periodontitis
- Emergency services to relieve pain
Most insurance companies see procedures that require anesthesia, surgery, or laboratory expenses as major care and tend to impose higher cost-sharing requirements from their policyholders. These lengthy and expensive services typically address exacerbated issues that could have been tempered earlier through routine preventative or basic care.
What Does It Cover?
Costly and complex procedures that fall under the umbrella of major care often include:
- Inlays and onlays to fill large cavities and cover tooth cusps
- Bridgework to fill in missing spaces left by one or more lost teeth
- Implants surgically placed in the jawbone to replace the roots of missing teeth
- Surgical removal of impacted wisdom teeth
- Anesthesia or sedation for long and otherwise painful surgeries
- Complex oral surgeries to treat emergency infections, injuries, or trauma
- Partial or complete dentures to replace missing teeth
- Repair of broken or damaged dentures
- Orthodontic treatments like braces, clear aligners, and retainers
How Dental Insurance Manages These Types of Care
Your share of costs for preventative, minor, or major dental services depends on whether you have basic or comprehensive insurance coverage.
Basic Dental Coverage
While coverage varies from policy to policy, basic dental plans typically include benefits for most preventative services and a few basic procedures like fillings or extractions. You can occasionally access these benefits as part of an employer-sponsored health plan. If not, you can purchase a standalone policy through the Health Insurance Marketplace or a private agency.
The average basic dental plan costs $31 monthly and charges little to no copay for preventive care. Most of these plans require a minor copayment for restorative procedures and occasionally impose annual deductibles. Your insurer will likely deny coverage if you have basic dental insurance but require a complex procedure like oral surgery, services from an out-of-network dentist, or orthodontic care.
Comprehensive policies typically include coverage for most preventative and dental basic services and major procedures like dentures, bridges, or braces. As with a basic policy, you can purchase comprehensive dental coverage through your employer, the Health Insurance Marketplace, or a private broker.
While prices vary widely, the average full-coverage dental plan charges a $53 monthly premium. After meeting your deductible, these policies often cover 100% of preventative care, charge a small copay for restorative services, and pay approximately 50% of major care. However, your carrier can still deny coverage for complex services not explicitly named in your policy, such as dentures or implants.
Choosing Between Basic and Comprehensive Care
Consider your unique medical needs and budget when choosing between basic and comprehensive dental insurance.
Select Basic Care If…
If any of the following situations apply to you, you would likely benefit from a basic dental policy:
- You want to save money on dental insurance
- You already have relatively healthy teeth and gums
- You do not need access to orthodontic benefits like braces or retainers
- You mostly want coverage for preventative care
- You can commit to a primary dentist’s office and will not require out-of-network services
- Less expensive premiums
- Coverage for restorative procedures
- Some preventative services are excluded
- No coverage for major dental work
- Higher out-of-pocket costs
Pros and Cons
Most basic dental insurance plans provide the following benefits:
- Little or no copayment for preventative services like cleanings, X-rays, and exams
- Each policy covers a few named restorative procedures, such as fillings or extractions
- Lower premiums than comprehensive coverage
However, consider the following shortcomings of basic coverage before purchasing a policy:
- Some plans exclude specific preventative dental treatments, such as fluoride rinses, from coverage
- Typically, only include minimal restorative coverage for minor cavities and gum problems
- Most policies do not cover implants, anesthetized surgery, orthodontic treatments, and other forms of major care
- Some plans impose additional restrictions, such as stringent provider networks or referral requirements
- Tend to charge higher out-of-pocket copayments for covered services
Select Comprehensive Care If…
Contrarily, you may prefer comprehensive dental insurance if you check any of the boxes below:
- You have more money to spend on monthly premiums
- You have a history of poor oral hygiene or current dental issues that may require frequent attention
- You want broader coverage for minor and major restorative services
- You want braces or retainers
- Fully covered preventative care
- Lower copayments for restorative care
- Some coverage for major dental work
- Higher premiums
- No coverage for orthodontic care
- Potential for high deductibles
Pros and Cons
Most comprehensive dental insurance policies provide the following benefits:
- 100% coverage for preventative care like bi-annual cleanings, exams, and X-rays
- Cover most minor restorative services, often for smaller copayments than charged by basic dental policies
- Partially cover some major dental services, such as wisdom teeth extraction, oral surgery, and implants
However, comprehensive coverage can present the following disadvantages:
- Higher monthly premiums
- Some plans still exclude specific major procedures or orthodontic care
- Many plans set annual maximums on covered services, after which members must pay 100% out-of-pocket for continued care
- Some plans still charge high deductibles or require members to receive care from in-network dentists or specialists
Putting It All Together
Dental issues can cause significant discomfort and negatively impact your overall health and well-being. While routine exams and cleanings should prevent many of these problems from arising, dentists occasionally must employ minor restorative techniques to address existing cavities or infections. Sometimes, people with more acute conditions may even require complex procedures like oral surgery, tooth implants, or even orthodontic care.
Coverage for these various services ultimately depends on your insurance carrier and whether you have opted into a basic or comprehensive benefits package. Remember to weigh your medical and financial priorities and compare policies on the Health Insurance Marketplace to ensure you secure dental coverage that adequately suits your needs.