Yes, most dental plans cover some types of restorative care to some degree. Restorative dental care includes everything that has to happen if preventative care breaks down. It ranges from basic work like fillings to major work like bridges. The types of restorative work covered and the cost depend on whether the procedures are considered […]
Yes, most dental plans cover some types of restorative care to some degree. Restorative dental care includes everything that has to happen if preventative care breaks down. It ranges from basic work like fillings to major work like bridges. The types of restorative work covered and the cost depend on whether the procedures are considered basic or major restorative. Most dental plans break out dental work into four basic groups of dental care procedures:
Diagnostic and Preventive Care:
This includes cleanings, a limited number of exams during the year and sometimes x-rays.
Basic Restorative Care:
Many plans cover 70 percent to 80 percent of routine restorative care, which could include amalgams, smaller composite resin or stainless steel fillings for cavities.
Major Restorative Care:
However, restorative care can also involve major work and these types of procedures are often covered at 50 percent or less of the total cost. Examples of major restorative care could include major fillings, gold restorations, bridges, dentures and individual crowns. Coverage for major work may be limited by the number of procedures and/or a dollar amount per year.
Coverage for large dental reconstructive works, including braces, are often restricted to patients under 19 years-old. Many plans do not provide any coverage for orthodontia at all.
Check Your Plan Handbook:
All dental coverage providers are required by law to give plan members an informational handbook that covers which kind of restorative care is covered at which level. If you have questions about types of coverages, exclusions or cost approximations, check you plan handbook or request a new copy. For example, in California, you can find helpful general information and advice about dental plans in the California Dental Association’s guide to consumer protection laws, and each state has their own oversight agency. You can find guidance for your own state regulations by visiting this list of state dental associations.
Dental Plans – Basic consumer information about terms and dental plans.
ADA – The American Dental Association’s report on preventative and restorative care.
CDA – The California Dental Association’s consumer guide to choosing dental plans.
State Dental Orgs — A list of dental associations for every US state from the American Student Dental Association.