What Is Full Coverage Dental Insurance?

Full coverage dental insurance typically refers to a dental insurance plan that covers a wide range of services, including preventive care, basic procedures, and major treatments.

Insurance companies sell two primary varieties of dental coverage. Basic dental plans cover preventative care, including cleanings and X-rays, and minor restorative services like fillings and extractions. However, if you want dental insurance with broader coverage, you must purchase a full coverage dental policy. Sometimes, these policies will even partially pay for orthodontic treatments like braces, aligners, or retainers.

How Full Coverage Dental Plans Work

Full coverage plans charge higher monthly premiums but cover a comprehensive range of services. Some plans require members to meet an annual deductible before accessing dental benefits, whereas others charge a flat copayment for every eligible procedure.

Notably, most policies require members to see in-network dentists and either deny coverage or charge higher copayments for out-of-network care.

Though benefits shift from plan to plan, comprehensive dental insurance typically provides the following coverages:

Preventative care covered at 100%
Basic procedures, such as fillings, covered at 80%
Major services, such as crowns or braces, covered at 50%

Some plans impose annual coverage maximums, after which patients must pay entirely out-of-pocket. Therefore, before purchasing dental insurance, you must thoroughly review and compare policies to ensure affordable coverage.

Eligibility

Most people who can afford the premiums and live in their insurer’s service area can secure dental medical insurance without much trouble.

However, the ACA does not have laws preventing dental insurers from denying coverage to people with pre-existing conditions. Individuals with missing teeth, gum issues, or other pressing oral health concerns may have to pay higher premiums for a full coverage plan or settle for a policy with fewer benefits.

Coverages

Unlike basic dental plans, which primarily focus on preventative care, full coverage policies offer many of the following benefits:

Preventative care: Routine hygiene and monitoring services like cleanings, exams, fluoride rinses, and X-rays that help catch or deter dental problems early in their development.
Basic care: Minor restorative procedures like fillings and extractions to treat cavities, infection, or gingivitis.
Major care: Complex and lengthy restorative techniques that often require anesthesia or surgery, such as bridgework, implants, or impacted wisdom tooth removal.
Orthodontic care: Smile and bite correcting hardware like space maintainers, braces, and retainers that ensure proper teeth alignment.

What’s Not Covered

Full coverage dental insurance will never pay for cosmetic procedures like teeth whitening, contouring, or smile makeovers unless an in-network dentist authorizes the service as medically necessary. Furthermore, members cannot receive benefits for medically necessary procedures explicitly excluded from their policy. Some plans also deny coverage for any care provided by out-of-network dentists or specialists.

Types of Full Coverage Dental Plans

Full coverage dental plans come in many different forms:

Dental PPO (DPPO): These plans cover the broadest range of dental services and have the costliest premiums. DPPOs even allow members to receive out-of-network care for a higher coinsurance contribution. However, they usually impose annual maximums, deductibles, and waiting periods.
Dental HMO (DHMO): DHMOs focus on preventative care and a limited number of restorative procedures from a preapproved network of dentists. While DHMOs rarely impose deductibles, annual maximums, or waiting periods, they require members to choose a primary dentist and secure specialist referrals. These policies deny coverage for all out-of-network care.
Dental EPO (DEPO): DEPOs only cover in-network dental care but typically offer a wider provider selection than DHMOs. Some DEPOs require specialist referrals from primary care dentists.
Dental POS (DPOS): POS policies allow patients to secure out-of-network care for partial reimbursement. This coverage gets determined against a “low table of allowances” that encourages policyholders to remain within network. Likewise, DPOS plans do not charge deductibles for patients who stay with their primary care dentist.

How Much Do Full Coverage Dental Plans Cost?

Though prices vary widely depending on your insurer, plan type, and location, full coverage dental premiums cost an average of $51 every month. On top of this, many of them require members to meet a deductible before accessing coverage and impose a percentage-based coinsurance for all eligible services. Plans that do not require a deductible usually charge fixed copayments for every covered procedure.

If a plan includes an annual maximum, members who exceed this limit must pay for all further services entirely out-of-pocket. While DPPO, DHMO, DPOS, and DEPO full coverage plans set independent restrictions, they all tend to cover close to 100% of preventative services like cleanings, exams, and X-rays.

Should You Get Full Coverage Dental Insurance?

When choosing between dental policies, always consider your unique needs and budget.

Consider If…

While full coverage dental insurance pays for a broad range of services, it might not suit everybody. Consider purchasing a policy if any of the following situations apply to you:

You can afford to pay higher monthly premiums.
You can afford any deductibles, coinsurance, and copayments affiliated with your plan.
You have a history of poor oral hygiene or current dental issues that may require frequent attention.
You want broader coverage for minor restorative services like fillings, extractions, or X-rays.
You want access to complex procedures like implants, crowns, or dentures.
You want dental insurance that covers oral surgery immediately.
You want braces or retainers.

Advantages

Purchasing full coverage dental insurance could give you access to the following benefits.

Complimentary preventative care services: These services include bi-annual cleanings, exams, and X-rays.
A broader range of restorative services: These services typically incur a copay but are less costly than if you had a less comprehensive dental plan.
Partial coverage for significant dental procedures: Procedures such as wisdom teeth extraction or dentures are very expensive without coverage.
Orthodontic care: Services like braces, space maintainers, or retainers are usually covered with full dental coverage plans.
Financial protection: Emergency dental issues or sudden pain can be costly to remedy without full coverage insurance.

Drawbacks

However, consider the following disadvantages before purchasing a full coverage dental policy:

Can be costly: Full coverage plans come with higher monthly premiums than less comprehensive policies.
Not all plans are equal: Some plans exclude specific major procedures or orthodontic care.
Annual maximums: Many plans set annual maximums on covered services, after which members must pay 100% out-of-pocket for continued care.
Can be restrictive: Some plans charge high deductibles or require members to receive care from in-network dentists or specialists. Full coverage DHMOs still require members to see a primary care dentist and secure referrals to other in-network specialists.
Waiting periods: Members occasionally must endure a waiting period before receiving benefits on non-preventative services.

How to Get Full Coverage Dental Insurance

Follow these steps when purchasing a comprehensive dental insurance policy:

Determine your current and future needs. Research and compare plans online and bookmark policies that cover all the services you or your family might require.
Consider your budget. If you can afford higher premiums and deductibles, you may prefer a DPPO plan. People with limited resources may want to settle on DHMO or DEPO policies.
Find a plan that contracts your preferred dentists. If your dentist falls out-of-network, you will likely have to find a new one or pay for their services entirely out-of-pocket.
Submit your application and pay your first premium. You can secure a full coverage policy through your employer, the Health Insurance Marketplace, or a private broker.

Alternatives to Full Coverage Dental Plans

If you cannot afford full coverage insurance, explore the following alternatives to ensure some level of dental care:

Basic dental plans: While these policies typically only cover preventative care and few named restorative services, they cost less than comprehensive insurance.
Dental discount programs: For a small annual membership fee, these savings plans provide partial discounts on preapproved services received at participating dentists’ offices.
Dental schools: Many universities offer reduced-cost dental services provided by practicing students.
Community health centers: These local establishments provide sliding-scale medical and dental care to people in low-income or underserved regions.
CHIP: A Medicaid expansion initiative, the Children’s Health Insurance Program requires all states to provide medically necessary dental services to children of low-income families.

All in All

While routine cleanings and exams can help prevent significant dental issues, most people still need restorative procedures like fillings, root canals, or crowns at some point in their lives. Though out-of-pocket costs and benefits vary from plan to plan, only comprehensive dental insurance covers the full spectrum of medically necessary dental care.

Before purchasing coverage, carefully weigh your budget, medical concerns, provider preferences, and access to affordable alternatives to secure a policy that adequately suits your unique needs.

Frequently Asked Questions

While full coverage insurance provides many benefits, it seldom pays for cosmetic dentistry. This includes teeth whitening, contouring, veneers, or dental bonding that serve no medical purpose. As with general health insurance, people who want elective procedures to fulfill aesthetic preferences must pay entirely out-of-pocket.

It depends on your policy. Though many full coverage dental policies cover complex procedures like crowns and dentures, only some provide orthodontic benefits. Most times, covered orthodontic care must come from an in-network specialist referred by your primary care dentist.

Yes and no. Unlike Marketplace and employer health plans, dental insurance carriers do not have to abide by ACA regulations and can deny coverage to people with pre-existing conditions like periodontitis, cracked or broken teeth, or oral cancer. However, some dental policies still allow these individuals to enroll in benefits for a much higher monthly premium.

Yes. When enrolling in coverage, you can usually choose between an individual or family-oriented plan. If you want to add a family member to your policy later, simply submit all required documents and application paperwork to your insurer. Once your family member clears medical underwriting, they gain access to all your same dental benefits for a slightly discounted combined premium.

Dental PPO and POS plan members can still see out-of-network dentists by paying a higher coinsurance than usual. However, DHMO and DEPO policyholders must pay 100% of the cost of out-of-network care. If your preferred dentist falls out-of-network, you can ask if they participate in a dental discount program. Otherwise, you must find a new dentist or enroll in a more flexible or compliant insurance policy.

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