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Understanding 100-80-50: What You Need to Know About Dental Insurance Coverage

December 8, 2023

Filed under: Uncategorized — mysaginaw @ 8:43 pm
Dental insurance form on a table

Determining what kind of coverage you can get from an insurance company is always a little bit difficult. Even when they’re transparent about what they pay out for certain kinds of claims, this information is sometimes buried deep in legalese and jargon that makes it hard to understand.

These problems are compounded in the case of dental insurance, which most people are a little less familiar with than general health plans. Making the most of your dental benefits entails understanding all that you can about what kind of coverage you can get in certain situations; that being the case, here’s what you should know about what payout you can expect from your dental plan.

Different Rates for Different Kinds of Care

The main thing you need to understand about dental care if you want to predict the level of coverage you’ll get is that dental insurance pays out for different kinds of care at different rates. While the precise numbers depending on your particular plan, they tend to break down like this:

Preventive Care

Most dental plans will cover 100% of checkups and cleanings, at least up to a certain number of them in a given year. Preventive care is the cheapest dentistry you can get and will make other procedures unnecessary by stopping oral health problems before they start. The high rate of coverage serves as an incentive for enrollees to get regular checkups, saving insurance companies money in the long run.

Minor Restorative Care

Simpler, more affordable kinds of restorative care aren’t covered at quite 100%, but you can usually still expect dental plans to pay for around 80% of the cost of the procedure.

Examples of minor restorative care include:

  • Fillings
  • Simple Tooth Extractions
  • Gum Disease Therapy
  • Some Root Canals

In addition to the rate of coverage, which treatments are considered minor can vary between dental plans.

Major Restorative Care

The most complicated treatments are often the most expensive, and will receive the least coverage. Dental plans may only pay around 50% of the cost of these treatments. Major restorative services include:

  • Crowns
  • Dental Bridges
  • Dentures
  • Surgery or Complex Extractions

Every dental plan is different. Coverage for these services can’t be absolutely guaranteed, and some procedures like orthodontics or dental implants are inconsistent between plans. However, the 100-80-50 rule can help you to budget for care more effectively, provided that you take it with a grain of salt.

About the Author

Dr. Rupeshwar Renkuntla has been in dentistry for over 20 years, yet his passion for his work and for the health of his patients has only grown with time. This is apparent to everyone who visits his office through his dedication and attention to detail. Dr. Renkuntla initially studied dentistry in India before moving to the Oklahoma, where he completed his education. He continues to study his field with the American Dental Association and the Texas Dental Association.

If you have any questions about dental insurance, he can be reached at his website or by phone at (817) 989-2832.

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