Does dental insurance cover dentures?

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Most comprehensive dental insurance policies include restorative coverage, which typically means up to 50% of the cost of dentures is covered. Regular deductibles and co-payments still apply, so the actual cost to the patient is always a substantial amount.

Key points to remember

  • Yes, dental insurance covers dentures.
  • It is considered a major procedure and is usually covered at 50% of the cost, you pay the balance.
  • Due to the maximum annual coverage limit, timing is of the essence; if you get dentures in a year that you’ve had other procedures before, your coverage can end up being significantly less than 50%.

What does dental insurance generally cover?

Dental insurance has a maximum annual coverage cap standing at a median of $ 1,500. It covers procedures strictly related to health and wellness, and it has a three-level structure known as 100-80-50.

Preventive care, such as annual cleanings, x-rays and sealants, is 100% covered. Basic procedures, such as fillings, extractions, and periodontal treatment for gum disease, are 80% covered. Major operations (crowns, bridges, inlays and prostheses) are covered at 50%. Depending on your plan, root canals can fall into the basic or main category. Most plans focus on preventative and basic care, and not all procedures are covered.

Most dental insurance plans provide for a waiting period before covering a major procedure, such as dentures, and this period can range from a few months to two years.

Limits of dental insurance

Most insurance companies have a waiting period for new patients, although some do not. This waiting period typically applies to non-emergency procedures, such as dentures, and typically ranges from a few months to 12 months, although it can be as long as two years for some companies.

Annual coverage limits, which can be as low as $ 1,000 despite the median mentioned above, can lead to a situation where a filling or decay lost earlier in the year has already consumed a large portion of the allowance. dental this year. This would likely result in dentures coverage below 50%, so you need to be strategic about when to schedule certain procedures.

Some employer dental insurance plans offer an option for lower monthly costs, but may offer little or no coverage for restorative procedures. Patients must pay the entire dentures bill in these cases. While it is possible to wait, it may be a good idea to switch providers when enrolling open for an option that includes denture coverage, as the savings can easily outweigh the higher monthly cost.

Discount plans

Discount dental plans are not insurance. They represent a group that has negotiated discounts and fixed prices for specific dental procedures to a limited number of dental professionals in the area. Those with no dental insurance at all and those with limited insurance coverage can see savings of up to 15% to 50% compared to regular prices. Your discount is given at the time you have your procedure, and you must pay at that time.

Since annual coverage limits typically cap at $ 1,500, while dentures typically start at $ 2,500 for upper or lower plaque, you will end up paying a large amount out of pocket when you purchase dental insurance for. get dentures. Discounted dental plans don’t have waiting periods or annual coverage limits, so if you can find the right plan, you’d better use one of them to pay for dentures. rather than using dental insurance, according to DentalPlans.com.

Before purchasing a discount dental plan, make sure the coverage meets your needs. Also check that participating dentists in the area do not have excessively long waiting lists for new patients.

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