WANT TO UPGRADE YOUR SMILE (& KEEP YOUR ORAL HEALTH IN CHECK?) WITH HEALTH INSURANCE FOR MAJOR GENERAL DENTAL, YOU CAN MAINTAIN YOUR DENTAL HEALTH WITHOUT THE HIGH COSTS.
If you're looking to upgrade your dental aesthetics with crowns, veneers, or dentures and unlock your best smile, major dental insurance is essential. Major dental treatments go beyond routine fillings and extractions (typically covered under general dental). Instead, major dental encompasses procedures like root canal therapy, crown placements, and dental implants.
These transformative treatments not only address oral health concerns but also enhance the appearance of your smile. However, they can be very costly procedures without the right insurance cover. In this guide, we'll walk you through the essential steps of selecting the right health insurance provider to ensure comprehensive coverage for your major dental needs.
Whether you're dealing with weakened teeth, chipped enamel, discolouration, or tooth loss, we'll help you navigate the world of major dental insurance to find the right cover for you.
WHAT LEVEL OF COVER DO YOU NEED FOR CROWNS, VENEERS & DENTURES?
The level of cover you need for crowns, veneers, and dentures can vary depending on your specific dental needs and preferences. Generally, these treatments fall under major dental procedures, which often require higher levels of dental cover for comprehensive coverage.
To ensure coverage for crowns, veneers, and dentures, it is recommended to consider a dental insurance plan that specifically includes major dental procedures. These plans typically offer a broader range of benefits and higher benefit limits to help offset the costs associated with these treatments.
It's important to review the policy details, including waiting periods, annual limits, and any applicable exclusions or restrictions related to major dental procedures. Additionally, some insurers may have preferred providers or networks where you can receive additional benefits or discounted rates for these treatments.
To determine the appropriate level of cover, consider factors such as your oral health history, the condition of your teeth, and any ongoing dental needs. Consulting with your insurer or a dental professional can provide valuable guidance in selecting a dental insurance plan that best suits your specific requirements for crowns, veneers, and dentures.
GENERAL DENTAL VS MAJOR DENTAL
GENERAL DENTAL
- Oral exams
- Scale and cleans
- Simple fillings
- Fluoride treatments
- X-rays
- Tooth extractions (can be General Dental or Major Dental, depending on your policy provider).
MAJOR DENTAL
- Tooth extraction
- Wisdom teeth removal (can be General Dental or Major Dental, depending on the policy you’re on). Wisdom teeth removal can be done in a hospital and so may require private hospital insurance.
- Complex fillings
- Crowns and bridges
- Veneers
- Dentures
WHAT ABOUT ENDODONTIC & ORTHODONTIC COVER?
Endodontics involves the treatment of the soft tissue within teeth, such as performing root canal therapy to address cracked teeth and remove inflamed tissue. You can learn more about endodontics here.
Orthodontic treatment involves the correction of teeth and jaws that are misaligned. This typically involves the use of braces or Invisalign to achieve the desired positioning. It's important to note that orthodontic coverage is generally included in higher-level insurance plans, but it often comes with longer waiting periods. You can find more information about orthodontic treatment here.
Depending on the specific level of coverage you have, access to these treatments and services may vary. More intricate dental procedures, such as orthodontic or endodontic treatments, are typically covered under higher-level extras policies.
It's also worth remembering that what is typically categorized as major dental coverage in one fund might fall under general dental coverage in another, and vice versa.
So, always review the details of your insurance policy to understand the extent of your coverage and which specific treatments are included.
DOES MEDICARE COVER MAJOR DENTAL CARE?
As an adult, Medicare only covers the cost of dental treatment when it’s essential to protect your general health. The public health system may also cover the cost of dental work if it’s part of a Medicare approved treatment. For example, if dental treatment is required prior to radiation for oral cancer.
Medicare may also cover the costs if you require hospitalization following a dental-related procedure. For example, if you need to be admitted for treatment of an infection that developed after having a wisdom tooth extracted.
Typically, Medicare will not pay for any follow-up dental treatment required once the general health condition has been resolved. The fees for specialists not related to the treated condition are also not covered.
OUT-OF-POCKET EXPENSES, LIMITS AND WAITING PERIODS
The level of major dental cover and the insurance fund you choose will determine 3 important factors:
- Your out-of-pocket expenses
- The limits of your cover
- When you can claim
When it comes to health insurance for major dental, it's important to be aware of how your insurer and Medicare cover different procedures.
While some treatments may be fully covered, others may require you to pay a portion of the cost out of pocket, known as a medical gap. To avoid any surprises, it's recommended to check with your potential insurance provider about their gap cover arrangements and any excesses that may apply.
ANNUAL LIMITS
WAITING PERIODS
It's important to note that extras policies typically have waiting periods set by the insurer.
These waiting periods prevent individuals from taking out insurance right before undergoing expensive procedures like root canals or braces. Waiting periods for major dental treatments can range from 6 to 12 months, depending on your insurer and the type of treatment.
However, for general dental, the waiting period can be as short as 2 months. In some cases, the waiting period for minor treatments like preventive check-ups may be waived entirely.
