Will your dental insurance plan cover your upcoming surgery? The answer to that question largely depends on which insurance provider you have, as every plan is different. That said, most of the time you can expect your insurance to follow a 100-80-50 structure. What does that mean, and does it include the treatments that your oral surgeon in Alexandria offers? Here’s an outline of what you need to know.
What Does Dental Insurance Coverage Normally Look Like?
If your plan falls under the 100-80-50 structure, you can generally expect the following coverage:
- Routine preventive care, such as the checkups and cleanings performed by your dentist in Alexandria, are covered up to 100%.
- Basic procedures like fillings are covered around 80%.
- Major procedures – such as most types of oral surgery – are covered around 50%.
The exact details of your coverage vary from plan to plan. For example, most providers consider dental crowns to be a major service, but some plans may have them classified as a basic procedure. Nevertheless, the vast majority of dental plans will follow the rule of providing higher coverage for preventive care compared to more complex procedures.
What Isn’t Covered Under Dental Insurance?
Dental insurance is meant to help pay for services that maintain or restore oral health. Consequently, cosmetic treatments like teeth whitening aren’t included most of the time. That said, there may be exceptions if a traditionally cosmetic treatment is shown to have some kind of oral health benefit.
Dental implants are in an unusual place when it comes to insurance. Many plans won’t pay for the actual implants, but they may still provide coverage for the restorations they support or any treatments used to prepare your gums and jawbone for implant surgery. Before getting implants, it’s a good idea to check with your insurance company to see what kind of coverage is available.
How Can You Get the Most Out of Your Coverage?
Once you fully understand what is and isn’t covered under your plan, you can start thinking about ways to maximize your coverage. Scheduling regular checkups and cleanings with your dentist can be an excellent way to use your insurance; your plan will cover most or all of the cost of your visit, and you can potentially avoid oral health issues that would require more extensive care altogether.
If you’re having extensive oral surgery that requires multiple visits, it may be a good idea to schedule the first appointments before the end of the year (or whenever your plan resets); that way you can use your current benefits to pay for the first part of treatment and will still have all of next year’s benefits to help cover the second part.
Understanding your dental insurance coverage could be the key to protecting your smile and your dental insurance. If you don’t understand your coverage, reach out to your dentist’s or oral surgeon’s office; the team there can walk you through your plan and help you develop a strategy for maximizing your benefits.
About the Practice
At Northern Virginia Oral, Maxillofacial & Implant Surgery, all of our oral surgeons are fully dedicated to helping our patients in Alexandria enjoy optimal oral health. We’re in-network with Aetna Dental as well as many other common dental insurance plans; we’re more than happy to explain your coverage to you and help file the paperwork to get the benefits you deserve. To schedule an appointment with us, visit our website or call (571) 777-6501.