How Do You Determine What Dental Treatments Are Covered by Your HMO?


Quick Answer

Dental treatments covered by an HMO largely depend on the company, policy and options of the HMO dental insurance plan. Most plans cover 100 percent of dental preventative and diagnostic services with varying coverage on cosmetic, orthodontia or other specific dental procedures. Consult the policy, HMO website or employer's human resource department for specific information about covered dental treatments.

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How Do You Determine What Dental Treatments Are Covered by Your HMO?
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Full Answer

In general, HMO dental insurance provides coverage at a fixed price with a patient copay at the time of service. The patient must also choose a dentist from the plan provider's preferred network.

In order to have the insurance plan that benefits the patient's needs and covers desired or needed dental treatments, consider under what situation the insurance will be used. Compare plans such as individual, family, student, senior, supplemental or short-term coverage plans. Consult with the provider, ask questions and choose which plan is most beneficial.

Some dental insurance does not completely cover procedures deemed cosmetic or voluntary. Check the provider's guidelines if specific procedures are covered or exempt. Examples of specific procedures are braces, veneers, tooth whitening, wisdom tooth removal and dentures. In order to find out if the specific procedure is covered, consult the insurance policy, the HMO's website or your employer's human resource department.

Most HMO dental insurance have an approved list of preferred providers. These dentists have agreed to the payment and copayment terms of the insurance provider and therefore usually offer a better value for the insured patient. Ensure the dentist list is acceptable or consider the different coverage offered for nonlisted dentists.

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