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What Is Major Dental Care?

Major dental care goes beyond routine check-ups and exams. It includes more complex oral procedures like crowns, bridges, and implants. Paying for these major dental procedures out of pocket can get expensive, which is why many people turn to insurance plans that cover major dental care procedures.

These types of dental insurance plans are more comprehensive than simple preventive or basic dental coverage and can be a helpful financial safety net if you’re expecting in-depth oral treatments. Learn more about the breadth of coverage major dental care insurance provides for a confident and secure approach to your dental health in this article.

What Are Considered Major Dental Services?

Major dental work includes treatments that go beyond routine care, addressing significant oral issues, and restoring optimal function. Common procedures include:

  • Dental implants: Permanent replacements for missing teeth, providing stability and functionality.
  • Orthodontic treatments: Correction of misalignments through braces or aligners for improved bite and aesthetics.
  • Oral surgery: Procedures like tooth extractions or corrective jaw surgery to address complex issues.
  • Crowns and bridges: Restoration of damaged teeth or filling gaps for enhanced functionality and aesthetics.
  • Root canals: Treatment for infected tooth pulp, preserving the tooth and preventing further complications.
  • Periodontal surgery: Addressing advanced gum disease with surgical intervention for oral health preservation.
  • Dentures: Replacements for missing teeth, contributing to improved chewing ability and speech.

These major dental interventions serve various purposes. Some are used to treat oral problems like cavities or gum disease after they’ve progressed to an advanced state, while others can help restore chewing and speaking habits. For example, if you’re missing teeth and unable to chew, getting dental implants can help improve your diet.

A good marker for determining if a procedure is basic or major is whether or not it requires anesthesia. Because of their in-depth nature, major dental procedures generally require anesthesia to perform, while basic ones do not.

How Major Dental Care Works

Major dental care is one of the more comprehensive types of dental insurance, as it offers extensive coverage for a wide array of essential services. You might also hear them called full-coverage dental plans.

Despite their comprehensive nature, major dental plans do not cover every dental service and might not fully cover associated costs. For example, many policies have coinsurance, where you pay a set percentage of the costs.

Also, purely cosmetic procedures might not be included. Typically, there has to be some identifiable goal for improving the function of the mouth for a dental treatment to be covered. So, if you were hoping to get braces to perfect your smile, that would only work if your dentist thinks you’re suffering from bite issues.

Additionally, some plans may have preferred providers or specific networks. To receive coverage from your insurance, you must visit providers from this network. Otherwise, you might have to pay your bills out of pocket.

Common Exclusions From Coverage

Major dental care plans, while comprehensive, often come with exclusions. While major dental care plans provide extensive coverage for essential treatments, they may not extend to elective or cosmetic procedures. Commonly excluded services include:

  • Cosmetic dentistry: Procedures like teeth whitening, veneers, teeth shaping, and gum contouring are usually not covered. That’s because these are primarily performed for aesthetic purposes.
  • Orthodontic treatments: Services related to braces, retainers, and other corrective measures for teeth alignment may not be covered if they’re solely for aesthetics. However, if your dentist is using them to realign your bite to improve functionality, they may be covered. It’s up to your plan to decide. If your plan does cover orthodontics, often there’s a waiting period before you can receive coverage.
  • Experimental treatments: Some elective or experimental treatments may not be covered. For example, researchers have been working on a new lozenge that could potentially rebuild tooth enamel. This would not be covered by insurance.

Costs to Consider

With major dental care services, there can be a lot of costs involved. Each plan is different, but here are some of the common ones you may encounter:

  • Premiums: Regular payments to maintain coverage. You typically pay these each month.
  • Deductibles: This is the amount you must pay before the insurance coverage kicks in.
  • Copays: These are fixed amounts paid at each dental visit, often applicable for routine services. For example, you might pay $10 for each exam.
  • Coinsurance: The percentage of costs shared between the individual and the insurance provider. These are typically set for each type of procedure. For example, you might pay 50% for a bridge while the insurance pays the other 50%.
  • Maximum annual limit: The highest amount the insurance covers in a year.
  • Out-of-pocket limit: The maximum amount individuals are responsible for in a given year, after which the insurance covers all costs.

Major Dental Care vs. Other Dental Plan Types

While major dental care offers more coverage, you can also choose between preventive dental plans and basic dental plans:

  • Preventive dental plans: These focus on routine care, covering regular check-ups, cleanings, and preventive care services. They are designed to maintain oral health and catch issues early because they cover the bare minimum and cost less than other plans.
  • Basic dental plans: Offering more coverage than preventive plans, basic plans include services like fillings and simple extractions. They address common dental problems but may not cover more complex treatments. These are a good middle ground in terms of coverage and cost.

Choosing the right plan depends on your needs. If budget is your primary concern and you want to keep your teeth healthy to avoid future problems, preventive dental plans might be a good choice.

When comparing basic vs. major dental coverage, major dental care is better if you expect several procedures throughout the year. For example, if you know your teeth are not in great shape, a major dental care plan can give you reassurance that you have the means to afford treatment. But basic dental care might make more sense if your teeth are in relatively good shape.

How to Find a Full Coverage Dental Plan For You

When seeking a full-coverage dental plan, consider the following factors to ensure it aligns with your needs:

  • Services covered: Evaluate what services are and are not covered in your plan. Make sure your plan includes essential treatments and any anticipated procedures.
  • Costs: Examine premiums, deductibles, copays, and coinsurance to understand the financial commitment and how it fits your budget. Many major dental plans cover major restorative procedures at 50%, meaning you’re on the hook for the other 50%.
  • Networks: Check for preferred providers or networks associated with the plan to ensure convenient access to dental care. Remember, going out of network could mean you do not receive any help from your insurance company.
  • Maximum annual limit: Understand the cap on annual coverage to gauge the plan’s adequacy for potential high-cost procedures. For example, if you’re planning on getting a full mouth of dental implants, this may exceed the annual coverage limit.
  • Exclusions: Review the list of services not covered to avoid surprises and assess the need for additional coverage.

What This Means For You

Major dental care plans go beyond routine services, offering extra coverage for dental procedures like implants and oral surgery. They can be a good choice if you want to lower your dental costs while prioritizing your oral health. While these plans provide extensive coverage, they do not cover cosmetic dentistry procedures. To find the right plan, consider factors like coverage breadth, costs, networks, and annual limits. Informed decision-making ensures your dental plan aligns with your oral health needs and financial preferences.

Frequently Asked Questions

No. Typically, major dental insurance plans cover everything from preventive services to major dental work. That’s why they’re also known as full-coverage dental plans. However, you may be able to purchase a comprehensive dental rider that only covers major dental services. This is like an add-on to your policy that extends your coverage in specific areas.

Insurance providers may categorize dental procedures differently. While there are commonalities in how procedures are categorized, differences can arise in the details. If you want to get a certain procedure done, carefully review each insurance provider’s policy documents, including the list of covered procedures and any exclusions.

Understanding these distinctions helps you make informed decisions when selecting a dental insurance plan and ensures clarity on the coverage provided for various dental treatments.

If you had a major dental procedure while uninsured, a new insurance policy would not retroactively cover it. Insurance coverage typically begins on the policy’s start date or after a waiting period, and it applies only to services obtained during the coverage period. However, check with specific insurance providers to understand their policies and any potential options for coverage.

Ensure coverage for your needed major dental procedure by reviewing your plan details, contacting your provider for clarification, and confirming network provider status. Check waiting periods, inquire about pre-authorization, and request a pre-treatment estimate to understand potential costs. Being proactive and well-informed about your insurance plan helps ensure you’re prepared for the coverage of your specific major dental procedure.

You’re responsible for the additional costs if your major dental procedure surpasses your coverage limit. Check your insurance policy for maximum limits and potential out-of-pocket expenses. Communicate with your dentist to discuss payment options and potential discounts. Planning and understanding your coverage limits beforehand can help you make informed decisions about your dental care and avoid unexpected financial burdens.

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