Major Services Dental Insurance Explained

Dental Health
By: Spirit Dental
July 28, 2015

A dentist going over a x-ray of his patients teeth with her

Understanding exactly what your dental insurance does and does not cover can be difficult at times. If you have a policy that provides major dental services coverage, what exactly does this mean? By taking the time to research this coverage, you can make sure that your policy will pay for the care that you need.

Most insurance policies divide dental services into three categories: preventative, basic, and major. In general, your policy is likely to provide the most coverage for preventative services, slightly less for basic, and significantly less for major procedures.

If you tend to have healthy teeth that you take good care of, you may be able to get away with a policy that primarily covers preventative and basic services. However, if you have a history of dental issues, it is a good idea to shop for dental insurance that provides more generous coverage for major procedures.

Preventative services are such things as examinations, X-rays, and cleanings. These are services that are intended to reduce the need for more significant interventions. Most insurance policies will cover at least 90 percent of the cost of these procedures, and many cover 100 percent.

Basic services are fairly straightforward procedures that can be easily performed by a general dentist and that do not require laboratory services. For example, a simple filling is a common example of this level of procedure. Most insurance policies tend to pay for 80 percent of the cost of basic services, though some are more generous and cover 90 percent.

Finally, major services are those that are more complex and involved, and that frequently require the attention of a specialist. A dental laboratory may also have to be involved. Because of the increased complexity and level of specialization that is required to deal with such issues, these procedures tend to be quite a bit more expensive than preventative or basic services.

Because of the rarity and additional cost, most dental insurance plans pay no more than 50 percent of the cost of major services. In addition, depending on the type of your plan, you may have to pay a co-payment as well. Your deductible may also apply.

Policies often come with a maximum benefits limit as well. This does not refer to the maximum amount that you will have to pay, but rather to the maximum that your insurance company will pay. For example, if you have a limit of $1000, then any costs that exceed that limit are your responsibility.

Common examples of major services include such procedures as root canals, dental implants, and orthodontic treatment. These are all services that need to be performed by a dentist who has specialized in this area. If your general dentist refers you to such a specialist, be sure to check and make sure that the office accepts your coverage.

Understanding what is covered by major dental services coverage is important, especially if you tend to have dental issues. Doing so can help you get the care you need at an affordable price.

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