Most comprehensive dental insurance policies include some restoration coverage, which usually 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 still 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 annual maximum coverage limit, timing is critical; If you get dentures in a year when you’ve already had other procedures, your coverage may end up being significantly less than 50%.
What does dental insurance generally cover?
Dental insurance has a typical annual maximum coverage cap amounting to a median of $1,500. It covers procedures strictly related to health and wellness, and it has a three-tier structure known as 100-80-50.Inasmuch asInasmuch as
Preventive care, such as annual cleanings, X-rays and sealants, are covered at 100%. Basic procedures, such as fillings, extractions and periodontal treatment for gum disease, are covered at 80%. Major procedures (crowns, bridges, inlays and dentures) are covered at 50%. Depending on your plan, root canals can fall into the basic or major category. Most plans focus on preventative and basic care, and not all procedures are covered.Inasmuch asInasmuch as
Most dental insurance plans have a waiting period before covering a major procedure, such as dentures, and this period can range from a few months to two years.
Dental insurance limits
Most insurance companies have a waiting period for new patients, although some do not. This waiting period generally applies to non-emergency procedures, such as dentures, and typically ranges from a few months to 12 months, although it can be up to two years for some companies.Inasmuch asInasmuch as
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 cavity lost earlier in the year has already eaten up much of the allowance. dental this year. This would likely result in less than 50% denture coverage, so you need to be strategic about when you schedule certain procedures.
Some employer dental insurance packages offer an option for lower monthly costs, but may offer little or no coverage for restorative procedures. Patients must pay the entire bill for dentures in these cases. If it’s possible to wait, it may be a good idea to switch providers when enrolling openly to an option that includes denture coverage, as the savings can easily outweigh the higher monthly cost.
Discount dental plans are not insurance. They represent a group that has negotiated discounts and fixed prices for specific dental procedures from a limited number of area dental professionals. Those without dental insurance — and those with limited insurance coverage — can save anywhere from 15 to 50 percent off regular prices. Your discount is granted at the time you have your procedure, and you must pay at that time.Inasmuch asInasmuch as
Since annual coverage limits generally top out at $1,500, while dentures typically start at $2,500 for an upper or lower plate, you’ll end up paying a significant amount out of pocket when using dental insurance to get dentures. According to DentalPlans.com, discount dental plans have no waiting period or annual coverage limit. If you find the right plan, you might be better off using one to pay for dentures than using dental insurance.
Before signing up for a discount dental plan, make sure the coverage meets your needs. Also check that participating dentists in the area do not have long waiting lists for new patients.