Will your insurance plan cover your dental needs? We receive a lot of questions about what insurance will cover and what is showing up on the bill, and unfortunately, insurance coverage is not always straightforward. Below we’ve answered some of the questions we get most frequently to help you navigate the labyrinth of your plan.
Key Takeaways: Navigating dental insurance can be complicated and frustrating. This post walks through common frustrations with dental insurance plans like sudden changes, common limitations on dental care, such as, long waiting periods for major coverage, downcoding, and missing tooth clauses, and what to look for in a plan. Dental membership plans can be a good option for patients looking for transparency in billing and coverage.
Table of Contents:
- What are dental membership plans
- What’s better: dental membership plan or insurance?
- What are the limitations of dental insurance?
- What to look for in a dental insurance plan
- How to check your dental insurance
- Are there initiatives to make dental insurance better for all Americans?
In 2025, we saw many insurance companies eliminate covered benefits with little to no warning. This can be incredibly frustrating for patients who signed up for a plan in 2024 only to find out that insurance wouldn’t pay for procedures they expected to be covered, leaving them to foot the bill.
Learn more about the massive changes to dental insurance plans
What are dental membership plans
At Montrose Dental Wellness, we advocate for our patients to get what they pay for, but navigating insurance plans is not always easy or straightforward. We introduced Wellness Loyalty Plans to provide our patients with access to preventive care, transparent pricing, and discounts on all services and procedures, eliminating the worry of navigating coverage, deductibles, and denials. These plans are offered in tiers that cater to specific life stages and dental needs.
What’s better: dental membership plan or insurance?
There’s no right answer to this question. Whether to go with dental insurance or a dental membership plan is an individual decision that will depend on your oral health, access to high-quality dental insurance, and anticipated dental needs. We accept most dental plans and see patients with good coverage and oral health who don’t require more care than is covered, but sometimes they are paying more for their insurance plans than a membership plan. We also see people not getting the dental care they need due to restrictions on their plans that leave them with large bills. For these patients, the Wellness Loyalty Plans are a good option because they offer transparency in billing and coverage, eliminating surprise costs.
Need an insurance agent who can help you navigate insurance on the Western Slope? Future Of Family Insurance Agency is a trusted agent.
What are the limitations of dental insurance?
Dental insurance can be highly restrictive on certain procedures, so it’s important to read the fine print. Here are some restrictions we often see with insurance companies. When patients run up against these restrictions, it often leads to frustration and ultimately a bill.
Beware of very low premiums! This often indicates a restrictive insurance plan.
Common exclusions and limitations include:
- Long waiting periods for major coverage (crowns, dentures, implants, etc.)
- Downcoding
- Missing tooth clause
- LEATs (Least Expensive Alternative Treatment)—another form of downcoding
- Significant non-covered services
- Significant frequency limitations
Typical frequency limitations we see include:
- Hygiene and exams: Two of each per calendar year (be careful of those plans that are exact six month and one day limitation on this as it doesn’t allow for any flexibility. Look for plans that allow 2 per year regardless of when)
- Fillings: Covered every two years per surface, per tooth
- Crowns, bridges, implants, and dentures: Covered every five years per tooth (crowns, bridges, implants) or jaw (dentures)
- Oral surgery: One extraction per tooth, regardless of timeline (some plans try to limit how many teeth can be removed in a year, which can be problematic for some patients)
- Periodontal Disease: Active treatment is typically reimbursed every two years, and maintenance is usually covered four times a calendar year.
What to look for in a dental insurance plan
When looking for a dental insurance plan, consider the following coverages. Not everyone has the same dental needs, but these are general coverages that most people need, especially if you’re over 50.
- Composite fillings
- Crowns, especially if you’re over 50
- Gum disease treatment—almost half the population will experience gum disease!
- Preventive care
- At least two hygiene visits a year, but the more the better for high risk patients who are prone to decay, heavy tartar build up, or gum disease
- Oral surgery
- Implants
How to check your plan
Checking for dental insurance coverage isn’t always straightforward. First, you’ll want to read through your policy documents. If the coverage you’re looking for isn’t easy to find, you can also call an insurance agent or the insurance company—remember that sometimes the representative won’t know the answer or will give incorrect information. Keep in mind that there is always a possibility your claim will be denied, regardless of what they tell you on the phone.
Are there initiatives to make dental insurance better for all Americans?
Yes! Many dentists are working hard on dental insurance reform. Dr. Horkan holds multiple seats with state associations to work with legislators to help rural Coloradans access the dental care they deserve. She is a member of the American Dental Association, Colorado Dental Association, Western Colorado Dental Society, Wellness Dentistry Network, and Kois Center Alumni.