Here you will find an overview of coverage for routine cleanings, exams, minor procedures, major procedures, coverage for the cost of dental implants, and coverage for the cost of orthodonture. In addition, consideration should be given to a deductible for procedures, whether procedures are covered in full or at a percent of charge, and whether dental implants cost or orthodontic insurance is included.

A dental insurance for individuals policy will typically include benefits for at least two categories; preventive and major / minor procedures. Preventive services are typically covered in full when you see a “network provider”. Utilization of network providers helps an insurance company to cap the cost of cleanings, exams, and other dental procedures by getting your dentist to agree to accept a contracted dollar amount. If a network or participating provider is not available in your area, your individual dental insurance policy will not be able to guarantee that any procedure will be covered in full. This is because dentists may charge whatever the market will bear for their services. The “participating” provider (dentist) will bill services directly to the dental insurer they are contracted with. The non participating provider will expect payment when services are provided, and the individual dental insurance company will reimburse you, to a benefit maximum, when you submit a copy of the bill.

Most dental insurance for individuals policies will include a deductible for minor procedures (cost of fillings), major procedures (cost of dental implants) and orthodontic benefits. In addition procedures are often covered at a percent of the total cost. An example of how an individual dental insurance policy might cover a dental implants cost: Participating provider agrees to accept $800 per transplant from an insurance company, and your individual insurance policy covers transplants at 50% after a deductible (let’s say your deductible is $100). The dental provider bills your individual dental insurance company $300. You pay the deductible of $100. plus another $400 which is 50% of the bill.

Individual dental insurance policies have a maximum benefit they will pay each calendar year. A typical annual maximum might be $1000. Orthodontic insurance (braces) is often not included, and if it is the benefit is often allowable only for children of a certain age, not adults.

The value of your dental policy is far greater than the limits you have paid for. Remember that if you see a dentist who has accepted to participate with your dental insurance carrier, then you reap the benefit of paying a pre-negotiated maximum cost. That means that the $800 transplant you and your dental carrier paid for could have cost you $1200 if you not had an individual dental policy.