What Is a Full Coverage Dental Insurance Plan?
Benefits & Out-of-Pocket Costs
Unlike Medicare Advantage plans and Affordable Care Act plans, dental insurance does not have a list of standard benefits shared among all plans. As a consequence, some dental plans have “bare bone” coverage while others have broad benefits. Given this disparity in benefit designs, consumers are asking, “What is full coverage dental insurance?”
In this article, full coverage dental plans will be discussed from the perspective of:
- Out-of-pocket costs
- Orthodontic services
Knowing the interrelationship between these issues will help a consumer find true full coverage insurance and ignore plans that claim wide coverage but pay for very little in actual practice.
Full Coverage Benefits
As mentioned earlier, there is no standard definition of dental insurance benefits. With that said, a full coverage plan should cover at the least:Preventive care
- At least two routine oral exams per year
- At least two teeth cleanings per year
- At least one dental x-ray per year
- At least two topical fluoride treatments per year
- A sealant is a protective coating applied to a tooth in order to prevent a cavity
- A plan may limit a sealant to one treatment for a tooth for a lifetime
- Fillings may have limits such as one per tooth per year or two years
- There is often different coverage for traditional fillings versus cosmetic white fillings
- Crowns benefits may vary according to the type of crown such as:
- Porcelain/Ceramic substrate
- Porcelain with gold
- Porcelain with non-precious metal
- Porcelain with semi-precious metal
- The replacement of a crown may incur different costs than the initial implementation of a crown
- Periodontics deals with the supporting structures of teeth such as the gums and the jawbone
- Care may be nonsurgical or surgica
- Root planing is an example of periodontic care
- Endodontics deals with dental treatments within the interior of a tooth, such as a root canal
- Services such as a root canal may have a limit of one per tooth per lifetime
Oral surgery coverage
- This includes not only surgery but related services such as deep sedation or anesthesia
A plan embodying the above care is not the end of the story. Just as important as the range of benefits is the out-of-pocket costs attached to those benefits.
Out-of-Pocket Costs of Benefits
Benefits are only half the story of full coverage dental plans. The other half is the out-of-pocket costs charged for those benefits. For example, if a plan only pays for 10 percent of the cost of a root canal, does that really constitute meaningful coverage of that benefit?
Dental costs come in four main forms:
- Copayments/coinsurance fees
- Maximum annual benefit
- Cost of uncovered care
Just as benefits are not standard among dental plans, neither are the out-of-pocket costs charged for their use. Deductibles, the out-of-pocket costs you pay before an insurance policy will begin sharing costs, average around $100. A very high deductible undermines the value of the dental insurance. With respect to coinsurance, where the enrollee pays a percentage of the total dental service charge, fees amounting to more than 50 percent of the service cost are often perceived as less than “full coverage” since the patient pays more for the care than the insurance company.
A dental plan’s maximum annual benefit, that is to say, the cap on the insurance policy’s benefit payments, is often around $1,500 annually. A full coverage plan is generally considered to have a maximum benefit of $2,500 or higher.
Finally, there is the matter of uncovered care. If the limitations of the policy or the narrowness of the dentist provider network significantly increases the probability of uncovered care, then it is reasonable to question whether the dental plan truly constitutes comprehensive coverage.
We normally associate orthodontic with the correction of misaligned teeth through the use of braces. While braces are certainly a matter of oral care, it is not a standard benefit within dental policies. Many dental plans have no benefits regarding orthodontic services. This is unfortunate since braces, and its attendant orthodontist visits, can cost around $5,000, though those costs may go as high as $10,000 in some cases.
Many dental plans fail to cover orthodontic services. Among those plans that do offer orthodontic coverage, look carefully at:
- The maximum amount the plan will pay towards braces
- The waiting period before orthodontic care will be covered
- The oldest age a dependent child may be in order to qualify for orthodontic coverage
- Network limitations
Do You Have Full Coverage Dental Benefits?
The information provided within this article provides a means by which to evaluate the breadth and quality of your dental benefits. If you find your dental coverage lacking, you should consider comparing other dental plans to establish how their benefit breadth and costs compare to your current coverage.