The question of getting dentures itself instills worrisome feelings. And on top of that, do you know that a single plate can cost you $2,500? A hefty tag indeed, isn’t it? Thus the need to understand the topic of dentures and how they are covered is essential. Therefore this article deals in-depth with does dental insurance cover dentures.
So, let’s begin!
The Cost Of Dentures
There are majorly two types of dentures. The first are lesser priced removable dentures. As already said, these are low-priced at $400to more than $1,000 per plate. The second option you have is custom-made dentures.
These are costlier, and their price range is around $2,500 per plate. The custom-made are built to fit perfectly on the jawline and stay there due to suction. If your denture is nicely made, you would not even need dental glue to keep it in place. It will just stay there.
Does Dental Insurance Cover Dentures?
So, putting it straightforward, insurance is not a very attractive deal when it comes to dentures. Although most policies provide some restorative coverage, i.e., they do cover dentures. But the problem is that they only cover 50% of the cost. Plus, you have to pay the copays and coinsurance costs. These add to the total expenditure you have to incur, which is quite substantial. Thus, dentures from dental insurance are not that attractive a deal.
Let’s now understand how does the insurance pay for these significant services.
How Does The Insurance Pays For Services?
First of all, the dental insurance has an annual cap of roughly $1,500. Yes, it means the insurance companies will pay a maximum of $1,500 in a year. If the costs of the treatment exceed this limit, you have to pay them from your pocket.
Secondly, they have a three-tier system for paying for services. They pay the 100% cost of preventive care and diagnostic services. Then comes the basic services. They pay 80% for basic services. Basic services include filling, extractions, etc. And lastly, they pay 50% for major services like dentures, inlays, bridges, outlays, crowns, etc.
Some services like a root canal can be included in basic or major services, depending on your policy provider. Most plans have a policy of focusing on preventive care. So that the disease does not grows and the costs and inconvenience both are less.
What Are The Limitations Of Dental Insurance?
Apart from this, there are other limitations of dental insurance too. Let’s see them one by one.
The most problematic of these is the waiting period. Most companies, if not all, have a waiting period. After you buy the policy, you have to wait for a certain amount of time before using it to pay your bills. This waiting period usually applies to procedures like dentures, etc., which are not an emergency. But the problem is that this waiting period can be as long as three months to two years. This clause is added to discourage those who buy policies to pay for impending procedures.
The next limitation is the annual coverage limit. However, we mentioned above that it is approx $1,500. But it can be as low as $1,000 in many cases. Thus, if you have already taken up a filling or extraction procedure with your doctor, you will not get much dentures coverage. Yes, the coverage can be lower than 50% for dentures then. It is so because you are not left with much balance on your limit. So, it would help if you would plan before you took up any procedure. Because when you need something, you may not have the balance.
The last limitation we will talk about is that some employer-funded insurance providers may not cover restorative procedures. If it is so, you will have to pay the whole bill of dentures from your pocket. And you know that is not at all a good option. So, what you can do is switch providers during the open enrolment. Only if it is possible to wait till open enrolment rolls in. We advise so because the savings you will make by getting coverage for dentures outweighs the higher monthly costs.
The Solution: Dental Discount Plans
So, if the insurance is not offering you a great deal, what or who will? Well, the answer is a dental discount plan.
Let’s get deeper into what are dental discount plans. Dental Discount Plans are groups that offer services at pre-negotiated discounts and fixed prices. They make available these services at a group of dentists in the area. On average, you can get 15-50% on the available services. And the best part is there is no reimbursement thing here. You get your discount when you pay. But you have to pay at the time you consume the service. It is an excellent facility for those who have no or lesser coverage insurance plan.
So, why to go for dental discount plans. Why are they better than dental insurance? Well, the answer is, because insurance has these limitations that dental discount plans don’t.
Insurance has this annual coverage limit of $1,500, but decent dentures start at $2,500 per plate. That’s way high than what the insurance covers. Plus, you have the waiting period. Dental plans are free from these limitations. With dental plans, you have to wait neither do you have an upper cap. Just avail the discount then and there. All you need to do is find the right plan that covers the right procedures at the right discounts at the right dentists.
So, this was all in our guide about does dental insurance cover dentures. We hope you liked it and that it was useful. So, now, if you have any doubts, then please ask them in the comments section below. Also, please tell us your comments on the article. We would love to hear from you!