What is full coverage dental insurance?
Learn what treatments and procedures full coverage dental insurance covers.
- Few, if any, full coverage dental plans cover every type of dental care at 100%
- Full coverage insurance can include a variety of different dental procedures and treatments
- Several types of dental plans provide full coverage for treatments and procedures that go beyond preventive care
“Full coverage” dental insurance may not mean your plan covers all services and procedures. That will depend on your policy and your insurance carrier. Few, if any, full coverage dental plans cover every type of dental care at 100%. The word "full" can imply that this form of insurance covers more than just preventive care and may include coverage for basic and major procedures and braces.
Procedures covered by full coverage insurance
Full coverage insurance can provide coverage for a range of treatments and procedures, ranging in severity. According to a 2016 ADA report, people who visited the dentist at least once accumulated an average of $685 in dental care.¹ Dental care is grouped into three main categories: preventive, basic, and major. Many dental insurance plans cover preventive care at 80% to 100%, basic procedures at 50% to 70%, and major services, such as surgery at 50%. However, coverage and costs can vary depending upon the plan level you select.
Preventive care and treatments included in this category include routine exams, X-rays, cleanings, and fluoride treatments. Out-of-pocket costs for these procedures can be costly and add up.
This type of dental care is less complicated than major procedures and used to treat minor issues to maintain good oral health. Basic procedures can include fillings, non-routine X-rays, and routine tooth extractions.
These procedures are some of the most complicated forms of treatment needed for major dental issues or emergencies. Root canals, major tooth extractions, complex oral surgeries, and dentures all fall under this category. A full-coverage plan is more likely to offer coverage for these procedures.
Things to consider when choosing full coverage insurance
Full coverage insurance can provide you with coverage for a variety of different dental procedures and treatments. If you are deciding whether a full coverage insurance plan is the right plan for you and your family, consider some of these questions.
What are your future dental needs?
Will you need a root canal in the next few months? Is someone in your family going to go through oral surgery in the next year? What about braces? When thinking about full coverage insurance, don't just think back to small routine check-ups and cleanings. Think about what procedures might be in your near-distant future, and whether the out-of-pocket cost will be something you can contribute. If you and other family members will need a variety of dental procedures or treatments, then the full coverage plan may be for you.
What about your dentist?
Have you found a dentist to suit your needs? When looking for a new coverage plan, talk to your dental office during your next routine check-up to see if they will accept your new insurance coverage. Frequently different carriers will have a pre-approved list of providers that are covered by their insurance, so you must be aware of the limitations and exclusions when it comes to your preferred dentist and a new possible coverage plan.
What’s your budget?
When shopping for a full coverage insurance plan, consider your budget and what you're comfortable paying. You should consider deductibles, coinsurance, annual maximums, and your monthly premium.
What’s the coverage plan like?
Consider the features of the plan you are looking to attain. It is important to note that full coverage does not always mean every procedure will be fully covered, but there should be a significant amount that is covered by your carrier, leaving you to pay less money on your end. Other things to consider about the plan you are eyeing are:
What are the types of treatments and services covered?
Full coverage dental insurance plans have a list of services that are covered in a plan summary document. Though you may not be familiar with all the procedures mentioned, the list should be significant considering the type of plan. Of course, the longer the list then, the more you should be reassured that you will receive the coverage for a significant amount of dental issues whenever the need arises.
Primary dentist requirement
If you select a DHMO, your plan may require you to go through your regular dentist to get a referral to see a specialist.
Some plans require major procedures to have a waiting period (time depends on the carrier) before being covered.
Types of full coverage dental insurance plans
Several types of dental plans provide full coverage for treatments and procedures that go beyond preventive care. Dental Preferred Provider Organization (DPPO) and Dental Health Maintenance Organization (DHMO) plans are the two main types of dental plans that may provide coverage for a variety of dental services and treatments. But they can differ in covered services, costs, plan maximums, and waiting periods.
What are the benefits of full coverage insurance?
One of the most significant benefits of full coverage insurance is that it encompasses a variety of dental procedures that range from basic to major. Full coverage plans may go beyond preventive dental care and can also cover basic and major restorative care, along with possible orthodontic coverage.
Improved access to care leads to better oral health
By getting routine check-ups for good oral health, your provider will also examine surrounding areas like the jaw and neck, allowing them to pinpoint any issues you may be having there as well. Preventive care can help lower your risk of tooth decay and other dental problems, which may harm your health in the long run. And a healthy mouth can also lead to a brighter smile, raising your self-esteem.
Healthy teeth for the whole family
Full dental coverage may also be beneficial for families, as many children and adults now need braces to fix crooked teeth and other significant dental needs. By adopting a full coverage insurance plan, you are also preparing your family for any future dental emergencies or necessities.
How to buy a full coverage dental insurance plan
There are a few ways to purchase full coverage dental insurance, including:
Enroll in a plan offered by your employer - If your employer offers dental insurance as part of your benefits package, or as a voluntary benefit when you start a new job or during open enrollment, which usually occurs in the fall.
Enroll in a plan through a trade organization - If you are self-employed and belong to a trade organization or other association, they may offer group dental insurance to their members.
Purchase an individual or family dental insurance plan directly - If your employer doesn’t offer dental insurance, you can purchase individual dental insurance from a dental insurance company over the phone, through a broker, or online. Limited options are available on healthcare.gov or your state’s ACA marketplace.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents, and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. It is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.
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