Your dental insurance plan determines your dental care coverage but several factors are involved. You’ll know if you have coverage at a dental appointment by understanding the difference between basic, preventative and major dental care, as well as the factors that insurance companies consider regarding coverage.
It's important to understand dental care in all aspects. Factors relevant to dental care coverage include the classification of dental care and which treatments each service type is available to you. These factors may affect financial responsibilities, waiting periods, and care options.
Dental Care Service Classifications
Private insurance providers add up to around 60% of spending on dental procedures in Canada. Providers organize dental care through different classifications. Coverage for each service category may differ between plans, depending on your needs. Dental services are classified as basic and major dental services.
More often than not, providers offer extensive coverage for essential services, while more thorough treatments may not reach 100% coverage. Check your plan to see which benefits you’ll receive.
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Basic Dental Care
While preventive dental care maintains dental health before problems arise, basic dental care includes restorative treatments that correct dental issues that preventative solutions can’t resolve.
Basic dental care includes services like routine cleanings and cavity fillings and is significantly more straightforward than major dental care. But, your coverage depends on your policy. Most plans cover up to 80% of costs after meeting a deductible, and beneficiaries may need to pay a copay with certain plans. More examples of basic dental care are:
- Non-routine X-rays
- Recementing dental crowns
- Stainless steel, prefabricated crowns
- Periodontal scaling and root planing
- Root canal treatment (this could also be considered a major procedure)
- Recementing dental crowns
- Routine tooth extractions
- Sedative fillings
- Composite fillings
- Amalgam fillings
- Pain relief
It’s important to remember that very few dental issues heal themselves. For this reason, ensure that your dental care plan is sufficient enough to cover routine cleanings and screenings. Delaying or self-diagnosing dental aches and pains can lead to major (and costly) problems down the road.
Preventative Dental Care
Diagnostic and preventative dental care is most likely the one that has the most amount of coverage on your dental insurance policy. These services are the ones that are the most performed during your yearly, or bi-yearly trips to the dentist. Preventative dental care is also considered routine dental care. The types of services that fall under this umbrella are:
- Tooth sealants (this can also be considered a basic dental service and limitations on age may be applicable)
- Fluoride treatments (limitations on age may apply)
- Space maintainers (this can also be considered a basic dental service and limitations on age may be applicable)
- Panorex X-rays, full mouth
- Periapical X-ray
- Bitewing X-rays
- Routine exams
Major Dental Care
Major dental care is any complex treatment, such as oral surgery. In many cases, treatments that require anesthesia and laboratory expenses fall under this classification.
A big difference between basic and major dental care is the amount of coverage. Since major dental care costs significantly more than basic services, many insurance companies set a deductible amount and cover up to 50% of the treatment cost. Copays are much higher for surgeries and other extensive treatments. More examples of major dental care are:
- Orthodontic treatment
- Denture rebases and re-aligns
- Removable partial dentures
- Complete dentures
- Sedations and anesthesia
- Impacted wisdom tooth removal
- Complex oral surgeries
- Tooth implants
- Onlays and inlays
- Dental crowns (this can also be considered a basic service, depending on the complexity)
When it comes to major dental services your typical plan, on average, only covers the reconstruction of a couple of teeth. That is, if that’s what the issue is. Plan limits can be easily exceeded if you require more work. This is why it is particularly important to invest in options that cover all of your basic needs so that major problems can be avoided in the future.
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Dental Service Inclusions
The primary difference between basic, preventative and major dental care is each service classification’s inclusions. It is important to know which treatments your insurance provider covers so it can help to avoid unexpected charges.
Procedures vary in their classifications depending on the provider and policy. Wisdom tooth removal, periodontal treatment, and root canal procedures may fall under the basic or major category. Your policy will specify which category each procedure belongs in. Having some general knowledge about what the Canadian Dental Procedure Code system looks like is an advantage.
Most often, surgical procedures are covered under major dental care. Some procedures, such as periodontal treatments, could be either surgical or non-surgical.
Waiting Periods for Dental Care
Your insurance plan might have waiting periods before you can get specific treatments done. You’ll either have less coverage or no coverage at all for a procedure during a waiting period. Major services like periodontal treatment and dentures often have waiting periods, while some basic services might also need policyholders to wait several months before receiving coverage.
Depending on the treatment’s complexity and classification, you might have a shorter waiting period. Most waiting periods last about six to twelve months.
Despite the differences between basic and major dental care, many preventive dental treatments don’t include a waiting period. These services are covered immediately, while coverage for more complex treatments come into effect later. Contact your insurance provider to learn more about each treatment’s waiting period.
Plan Service Coverage
Your dental costs won’t be zero despite having a full coverage plan. Some people may still have payment requirements depending on the type of plan. Copays (or co-insurance) are fees you pay when getting a service, while deductibles are expense totals you need before your insurance provider covers the treatment.
Insurance providers typically pay for the less expensive procedure if multiple treatments resolve your dental problems. Despite this inconvenience, dental insurance still lowers costs for major dental care. Providers cover the amount of the cheaper treatment, and patients pay the rest of the expenses out-of-pocket.
Another difference between basic, preventative and major dental care are the service limitations. Many providers have restrictions on the treatments they’ll cover, how often you can receive each treatment, and the providers you can choose from.
- Restorations: Your plan can include coverage for minor restorative care for worn teeth, such as erosion or fillings. Major restorative care can be expensive depending on your dental policy’s inclusions. Plans can cover specific materials for fillings and other therapeutic treatments.
- Non-cosmetic procedures: Dental treatments like teeth whitening, veneers, tooth-coloured fillings, and dental crowns are cosmetic. You can only get coverage for non-cosmetic procedures.
- Treatment frequency: In addition to waiting periods, a lot of policies put limits on the number of dental services they’ll cover in a given period. For example, you might have to wait as long as five years between non-routine X-rays. Major dental services can have much longer waiting requirements.
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Contact our experts if you’re still unsure how the difference between basic and major dental care impacts your dental insurance coverage and what you can expect. Our skilled team is happy to answer your questions and search for the perfect plan by comparing side-by-side quotes from Canada's top health and dental providers.
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