2 Free Cleanings A Year…..

The Big selling point for most dental insurance policies is that policyholders and their dependents will receive two free cleanings per year, but is that really the case? In short the answer is no, while many insurance companies reimburse for preventative and diagnostic services at 100%, the amount paid for these services is not subject to the plan deductible, but is deducted from the yearly maximum.

That’s right dental insurance policies have yearly maximums as well as deductibles that apply to most services. The typical dental policy allows for $1000-1500 yearly maximum, once that amount is paid there are no more payments made for the year; this includes any payment for dental hygiene services, or treatment to other providers such an endodontist or oral surgeons. In addition most policies have a $50-100 deductible that must be satisfied prior to reimbursement on the insurance company’s part. Once the deductible is satisfied the insurance company will pay a percentage of the cost for a service up to the yearly maximum, most companies reimburse at the rate of 80% for basic restorations such as fillings and simple extractions, and 50% for major services such as crowns, root canals and dentures. The percentages are usually paid based on the reasonable and customary amounts for the area, but may be paid on the employer’s fee schedule. These amounts are determined by your insurance company and vary depending on the insurance company and policy.

There are also exclusions and limitations that apply to dental policies, for instance many companies do not provide benefits for initial replacement of a tooth that was missing prior to coverage with their company.

The bottom line is dental insurance is helpful, but it does not cover everything, and as the old saying goes “the best things in life are free” unfortunately that does not include dental cleanings.