Key takeaways
- Major services is a plan category, not a complexity rating. Crowns, bridges, dentures, root canals, surgical extractions and implants all generally fall into this tier.
- Before any major work, ask your dentist for a pre-treatment estimate. It tells you what your plan will cover and what you’ll owe before you commit to anything.
- Not every dental plan covers major services. Confirming what’s included before you enroll is the most important step you can take when major work is already on the table.
Picking a dental plan feels straightforward enough at the time. You think “full coverage,” sounds right, so you enroll and move on. It’s only when your dentist recommends something major and puts a number to it that you start wondering what your plan is actually going to cover.
Dental insurance has more layers than it seems. Those layers matter a lot more when you’re looking at a crown or a root canal than when you’re booking a cleaning. Understanding how coverage works before major work starts means you’re not figuring it out as you go.
What Full Coverage Means in Dental Insurance
Full coverage dental insurance includes three categories of care: preventive, basic and major services.
- Preventive services include your cleanings and exams.
- Basic services generally include services like fillings and simple extractions.
- Major services generally include the bigger procedures like crowns, bridges, root canals, dentures and implants.
What varies across those three categories is how much of the cost the plan takes on. Preventive care is typically covered at the highest percentage. Major services are covered at a lower one. Three variables determine what you pay out of pocket:
- Deductible: what you pay before your plan starts contributing
- Coinsurance: your share of the cost after the deductible is met
- Annual maximum: the most your plan will pay in a benefit year. If treatment costs more than that, you pay the difference.
For major dental work, the annual maximum deserves a closer look. Major procedures can add up fast. If you need more than one major service in the same year, it helps to know how much your plan will cover before you hit that limit.
Understanding Major Services and Where Your Procedure Fits
In dental insurance, “major services” is just a category name. It doesn’t mean the procedure is complicated or rare. A surgical extraction, for example, is a common procedure that still falls under the major services category.
Procedures that typically fall under major services include:
- Crowns: a cap placed over a damaged tooth when a filling can no longer restore it
- Bridges: a fixed appliance that replaces missing teeth by anchoring to adjacent teeth
- Dentures: removable set of fake teeth to replace missing teeth. Full dentures replace an entire arch, partials replace some
- Root canals: treatment for an infected or damaged tooth nerve in a permanent tooth
- Surgical extractions: removal of teeth that require more than a routine pull
- Implants: a surgically placed post that supports a replacement tooth
Not every dental plan covers every major service. The gap between what you assume is covered and what is covered can be a costly surprise. Implants are a good example. Some individual plans include them, others don’t. Before you schedule anything, check your plan’s summary of benefits to confirm your procedure is covered.
Even when a procedure is covered, most plans set boundaries on how often they’ll pay for it. That’s called a frequency limitation. A crown or a bridge is typically covered once per tooth within a defined period, not every time you need one. Before scheduling more work on the same tooth, it helps to know whether enough time has passed for the procedure to be covered again.
A pre-treatment estimate is a good place to start before any major work begins. Your dentist sends the proposed treatment to your insurance company before anything is scheduled. You get back a breakdown of what your plan covers and what you’ll owe. That way you know the numbers before you commit to anything.
Waiting Periods for Major Dental Work
A waiting period is a set amount of time after your plan starts before certain services are covered. If you sign up for a plan with a nine-month waiting period and then need a crown in month three, that crown won’t be covered by your insurance yet.
Waiting periods are most common with major services. How long that timeline is depends on the coverage you have. Some plans require a six-month waiting period before major services are covered. Others require nine. Some have no waiting period at all!
If you recently had dental coverage and didn’t experience a long gap, your new plan might waive the waiting period for major services. But it’s not always automatic. Check the benefits summary for your new plan before assuming major services are available right away.
The Right Plan for Upcoming Major Dental Work
When major dental work is on the table, the first question isn’t which plan has the best premium. It’s whether the plan covers major services at all and when.
Most Delta Dental of Arizona traditional individual plans cover major services with a waiting period. The waiting period may be waived if you meet specific criteria. Incentive plans start covering major services right away, and your coverage gets better the longer you stay enrolled.
If you need major dental work but aren’t quite ready to commit to a dental insurance plan, you might consider a discount plan. Discount plans are not insurance. They’re a membership program that lowers the cost of dental procedures with participating dentists. With Delta Dental Patient Direct there are no waiting periods, no annual maximums and no claims to file. It won’t cover the way dental insurance does, but it could help offset some out-of-pocket expenses.
Frequently Asked Questions
Full coverage dental insurance refers to plans that include all three categories of dental care: preventive, basic and major services. It doesn’t mean everything is covered at 100%.
Major services are a specific category under your dental plan that generally includes procedures like crowns, bridges, root canals, surgical extractions and implants. It’s a plan classification, not a measure of how complex or uncommon a procedure is.
No. Some plans require six to nine months before major work is covered. Others have no waiting period at all. If you recently had dental coverage, your new plan might waive the waiting period. But it isn’t automatic, so confirm directly with your dental carrier.
It depends. Implants are covered as a major service on dental plans that include full major service coverage, but not every individual dental plan covers them. Check your plan’s summary of benefits before assuming implants are included.
You can enroll in dental insurance regardless of what major work you need. However, if the plan has a waiting period for major services, you might need to wait before those benefits are available. A plan with no waiting period—or a waiver based on prior coverage—might be worth looking into if treatment is already recommended.
In some cases, yes. If you had dental coverage before enrolling in a new plan and there was no significant break between the two, waiting period for major services may be waived. This varies by plan and isn’t guaranteed, so confirm with your dental carrier directly before enrolling.
Yes. Delta Dental of Arizona offers individual dental plans that cover major services, including both traditional and incentive plans with no waiting period. Not every individual plan includes major services, so reviewing the plan details before enrolling is the right first step. You can compare plans at deltadentalaz.com/shop-for-plans.
