General Family Dentist | Milwaukie, Oak Grove, Gladstone, Happy Valley and Portland, OR

Kevin H. Speer, D.D.S.
2250 SE Oak Grove Blvd.
Milwaukie, OR 97267

Mon-Thur
8am–5pm

Does My Dental Insurance Cover That?

Approval stamp on an insurance coverage document

If you need to have dental work done and you currently have dental insurance, you may be wondering whether or not your dental procedure will be covered. Since dental insurance differs from medical insurance and is designed to offer partial coverage, the short answer is that your dental insurance will most likely cover a percentage of the cost of your treatment.

Most dental insurance companies follow what is known as the 100-80-50 model. This means that most dental insurance companies will cover 100% of the cost of preventative procedures, such as routine checkups and cleanings. Most companies offer full coverage for two dental checkups a year. Restorative procedures, such as fillings or root canals, are usually covered at 80% of the total cost. Finally, major treatment procedures, such as crowns or bridges, are covered at 50% of the total procedure cost.

There are also certain things that dental insurance companies will not provide coverage for. Most dental insurance companies will not provide coverage for any type of cosmetic procedure. This includes porcelain veneers or teeth cleaning. They will also not provide coverage for any preexisting conditions. There are some dental insurance companies that will cover orthodontic procedures, however.

There are two main types of dental plans available, DHMOs and DPPOs. Both plans are structured similarly to medical HMOs and PPOs. With a DHMO, you, your employer, or a combination of both would pay a monthly fee to the insurance company. In return, you select one dental provider as your primary care provider and receive exclusive coverage. DHMOs are helpful because they have higher rates of coverage than PPOs. However, the services covered are often not high quality and can even be slightly outdated.

The other option, DPPO allows you to choose from a variety of providers, giving you extra flexibility in your dental treatment. Because of this, however, your coverage levels vary depending on a number of factors. One of these factors is whether or not your dentist is considered “in network” or “out of network”. A common downfall of the PPO is dentists that fall into the “out of network” category often have low levels of coverage and higher out of pocket costs. Just like with a DHMO, a monthly fee must be paid to the insurance company by yourself, your employer, or a combination of the two.

In addition to the rates of coverage, it is also important to note that your coverage with most dental insurance companies only begins when you have paid your yearly deductible. A yearly deductible is a set amount that the insurance company requires you to pay before they pay anything. Essentially this means that you have no coverage until this amount is paid in full.

It is also important to realize that with most dental insurance companies, your coverage also has a yearly maximum. This amount is usually within the price range of $1,000-$2,500. Once you have hit this limit, your coverage essentially runs out and the insurance company will not pay more. This means any remaining expenses will have to be covered out of pocket.