What does dental insurance cover?

Dental insurance can be helpful. However, it’s important to understand what you’re covered for. If you’re paying for dental as part of your health insurance cover, it just makes sense to use your benefits every year. But don’t expect your insurance to cover the cosmetic work you’ve always dreamed of.

Where a dental plan can help is when you encounter unexpected dental costs—if you accidentally knock out a tooth or need work such as a filling. In addition, dental insurance helps reduce the cost of general care and maintenance of teeth, such as regular dental check-ups and scaling and cleaning.

Check Your Dental Cover

As health insurance policies all differ, it’s important to read the fine print on your dental cover so that you are clear:

  • What kind of procedures your policy covers: If you only have a basic premium it may not include insurance rebates for treatments such as orthodontic dental work or hospital visits for removal of wisdom teeth.
  • If your cover includes cosmetic procedures: Many policies don’t include cosmetic procedures such as veneers, implants, teeth whitening, inlays and onlays.
  • Whether you can add on coverage. This then allows you to claim for a wider number of dental treatments and procedures.
  • Whether you will pay a gap fee: Depending on your insurance policy and the dental treatment you undergo, you may receive a rebate of around 50% to 100% of the total cost. Make sure you are clear on what amount of gap fee you have to pay so you don’t get caught out unable to cover the shortfall.
  • Whether there is a waiting period: For most health insurance packages, you need to wait 12 months before you can claim for some procedures and you may not be covered for treatments for a pre-existing condition.
  • If your insurer caps claim amounts: This means that you can only receive a certain amount of money back for particular types of procedures per year.

Insurance Cosmetic Procedures

Most dental health insurance does not cover procedures the insurance company says is ‘cosmetic’. Unfortunately, you may fall afoul of this if you have one of those procedures as part of essential dental work. For example, if you had a cracked tooth, you may need a veneer to ensure the repaired tooth matches the appearance of your other teeth. That veneer would be classed as ‘cosmetic’ work, so the insurance company may not cover it.

We usually give our clients the health insurance item numbers so they can check beforehand whether their health policy will cover their upcoming dental work.

Alternatives to dental insurance

In cases where clients are not covered for dental procedures or treatments, we offer a free payment plan to help them with their cash flow and dental budget.

Alternatively, some people may save up before electing certain procedures, such as cosmetic dentistry. This isn’t a bad option, although it does require a fair bit of discipline when it comes to saving.