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Posted by Staff on Jan 08, 2015   ::   Tags: Insurance, Benefits
DATE: 01.08.2015

As we say goodbye to 2014, it’s important to understand what your dental insurance plan has in store for the New Year. Most of us cringe at the thought of deciphering dental insurance, after all, it can be a tricky topic. At Cromwell Dental our expert team works with numerous insurance companies and would be more than happy to answer any questions you may have.

Often times it is assumed that dental insurance works similarly to health insurance – but they are not the same. The biggest difference between the two is that dental benefits focus on stopping problems before they start and health benefits focus on treating injury and illness after they have happened. This is why most dental insurance policies include 100% coverage for two hygiene visits each year, but offer little to no assistance for the more complex work. The logic behind this is, if you keep your mouth healthy, hopefully you won’t need additional treatment.

When one of our clinical team members recommends an additional treatment or procedure, it is solely to benefit your oral health, and not dictated by your insurance coverage. Your policy is meant to mainly cover preventative services (annual cleanings, fluoride, etc.) and be an aid for anything else. In other words, you’re dental insurance might not cover all the dental work you need. To get a better understanding of this, you should know that your plan is most likely categorized into three tiers of benefits. The first tier is comprised of the preventative services mentioned earlier, such as cleanings, consultations and sometimes even emergency visits, which are covered the most – usually 100%. The second tier, referred to as “basic” or “restorative” services, include fillings, root canals, and sometimes periodontal maintenance visits. These procedures are usually covered at 80% of the cost or less. The final tier, is termed “major” services, which consist of just that – major procedures. These include, but are not limited to, crowns, bridges and implants, and are often covered much less than the other two tiers, if at all.

So what does this mean for you? If you come in for a procedure that is covered by your plan at 80% of the cost, the remaining 20% is your responsibility. This patient portion is called your copayment or “copay” and will be due at the time of service. Your copay can be a little more or a little less depending on whether or not you’ve met your deductible or maximum for the year. Your deductible is applied and paid by you when you have your first appointment for dental treatment, like a filling or crown. Your maximum is not how much you have to pay out of pocket, but rather, the total amount your dental plan will pay towards any care you receive throughout the year. It is always a good idea to know what these amounts are so you are never surprised at the end of your visit. As a courtesy, we will let you know if you’ve maxed out for the year, meaning you have used up all of your benefits. Likewise, we will let you know before the end of each year if you have not.

We hope these tips help clear some of the confusion surrounding your dental benefits for the year. If you have insurance through your employer, your HR Department is a great resource for details about your plan. But calling your insurance company directly will provide you with the most up to date and accurate information. 

Happy New Year!



Untreated dental disease can lead to serious long-term problems. The American Dental Association recommends all adults and children visit a dentist every six months. Whether you're a current or future client we hope to see you soon!