Understanding Your Dental Plan

A dental plan can help you cover some of the costs of you and your family's dental care. However, it is important to understand that your dental plan may not cover all of your treatment needs.

For the most part, dental plans are purchased by your employer as part of a group benefits plan. The treatment and services covered and the percentage of coverage can vary widely based on the plan purchased.

What Does Your Plan Cover?

It's important to understand what your dental plan covers and what costs you will be responsible for. Ensure you have this information available and confirm any changes before you visit the dentist. Ask your employer for a plan booklet. In particular, be aware of:

  • Plan limits: Does your plan have a yearly maximum based on a fixed dollar limit (i.e. $700 total coverage) or the frequency of services provided (i.e. units of scaling, or recall exams).
  • Percentage of coverage: What percentage of each treatment is covered? For instance, many standard dental plans will cover 80 percent for preventive dental services (exam, X-rays, cleanings, fillings) and 50 percent for other procedures (crowns, bridges, veneers and dentures). It is rare for a plan to cover 100 percent of services.
  • Fees covered for each procedure: Dental plans reimburse based on the plans fee schedule; this may differ from the fee your dentist charges. For instance, if your plan's schedule is $100 for a particular procedure (pays 80 percent of this fee) but your dentist charges $120 for the same procedure your dental plan will still only cover 80 percent of $100, or $80. You will need to pay any remaining costs, in this case $40.
  • The co-payment: This is the portion of the plan that you are responsible for paying. For instance, if your plan covers 80 percent of a procedure, you are responsible for the remaining 20 percent. You are responsible for any costs not covered by your plan.
  • Specialist fees: While some plans may reimburse specialist fees, it is rare. Your plan will only pay for the portion of the cost based on the rate at which they reimburse. You are responsible for any variations.
  • Lab fees: As part of your treatment your dentist may work with an outside lab. The lab sets its fees independently of the dental office; lab services may or may not be covered.
  • Dual coverage: You may be eligible for additional coverage if you are also covered under a spouse/partner's dental plan. In this case your dental plan provides the primary coverage while your spouse or partner's plan may provide some additional support. However, this may not apply if the two plans are with the same company.

Also review the Frequently Asked Questions: Dental Plans.