Posted by Although many would love to do the deep cleaning as recommended by their dentist, about 32% of Americans postpone it due to cost. More importantly, they ask the question “Does my dental insurance cover deep cleaning?*
Actually, it does, and we will tell you how in this article. In addition, we will help you learn important steps to get the best out of your insurance coverage for deep cleaning, and how to prevent deep cleaning altogether.
Are you excited?
Let’s go!
Table of Contents
What is Deep Cleaning?
Deep cleaning is also known as scaling and planning. It is a procedure used in dentistry to flush away hardened minerals which are also known as (tartar) hidden in your gum line.
Deep cleaning involves 2 steps:
- Scaling: Scaling is the removal of the hardened tatar that has built up beneath your gums where regular cleaning procedures can’t reach.
- Planing: Planing is the smoothening of any rough tooth surfaces found in your mouth. This is to discourage future accumulation of tartar in your gum and also keep your gums healthy.
Does Dental Insurance Cover Deep Cleaning?
Yes, your dental insurance plan will cover deep cleaning, but this largely depends on the type of policy your plan operates on or the conditions that demand the deep cleaning procedure. The coverage of deep cleaning will depend on how your individual plan categorizes the treatment.
For you to understand better, let’s briefly explain the plan categories.
Dental insurance plans typically have three main categories for coverage:
- Preventive
- Basic
- Major
#1. Preventive:
This category includes routine dental procedures like exams, cleanings, and fluoride treatments. It is crucial in oral hygiene. Additionally, if gum disease is detected in the early gingivitis stage, deep cleaning may fall under this category.
#2. Basic:
This category covers more complex procedures like fillings and crowns. In some plans, deep cleaning for moderate gum disease (periodontitis) might be covered here.
#3. Major:
This covers heavy cases like surgeries and other extensive restorations. If you have severe gum disease, deep cleaning could fall under this category.
If you’re still confused about these categories, we recommend that you look through the Summary of Benefits and Coverage (SBC) document of your insurance policy.
Your SBC document contains all the information you need to know about your coverage, including what is covered for deep cleaning. We advise that you take time to carefully read it and make sure you understand everything.
It’s important to note that many dental insurance plans cover a percentage of the cost, typically ranging from 50% to 80%. Some dental plans have a maximum annual benefit, which limits the amount they pay per year. This can impact the cost of deep cleaning for you.
So make sure you ask the right questions.
Feel free to check this out: Does Dental Insurance Cover Bonding?
Factors Affecting Your Dental Insurance Cover For Deep Cleaning
Now that you know dental insurance partially covers deep cleaning, let’s explore the factors that can affect your specific coverage:
- Type of plan
- Frequency of deep cleaning
- In-Network vs Out-of-Network Providers
- Deductibles and Annual Maximums
- Type of Gum Disease
- Insurance Coverage Percentage
- Location
- Additional Costs
1. Type of Plan:
Know that the specific type of plan you have ultimately affects your coverage level.
- PPO plans offer you the most flexible and comprehensive coverage when it comes to deep cleaning and it covers 50%-80% of the procedure cost.
- In HMO plans, you may face more restrictions and you may also require referrals from your primary care dentist before you can obtain coverage for procedures like deep cleaning. Sometimes it covers 30% to 50% of the deep cleaning cost.
- In indemnity plans, you are offered a reimbursement based on fee schedules that have been pre-determined and this may not give you full coverage for deep cleaning. The percentage you get can vary significantly from 20% to 70% but it depends on your specific plan and your benefits.
If you do a thorough assessment, you will discover that PPO plans offer you the most flexible and comprehensive coverage when it comes to deep cleaning compared to HMO or indemnity plans. Make sure you study your insurance plan booklet to understand its details and the specific costs it covers.
2. Frequency of Deep Cleaning:
Unlike other sectors, insurance companies aren’t always fans of repeat customers. They usually provide better coverage for the treatment of gum disease than they do for deep cleaning if it is done for routine maintenance.
If you opt for regular cleaning, it is important to keep in mind that there may be different rules and restrictions that apply.
So, make sure you review your plan for limitations, including the frequency of covered deep cleanings.
3. In-Network vs. Out-of-Network Providers:
From our experience over time, choosing an in-network dentist for deep cleaning can result in higher coverage for deep cleaning and lower out-of-pocket costs compared to going out-of-network. So, know that dental plans may only cover deep cleaning within their network.
4. Deductibles and Annual Maximums:
Before your dental insurance coverage starts, you have to pay a specified amount out-of-pocket for the covered services. Deep cleaning costs may count towards your deductible.
Secondly, each dental plan has an annual spending cap, which is the maximum amount they will cover for all services combined. If you reach this cap, you may be responsible for any remaining deep cleaning costs.
5. Type of Gum Disease:
If you catch early gum disease (gingivitis), your deep cleaning may be covered under the preventive category, offering potentially higher coverage percentages.
However, if you catch advanced gum disease (periodontitis), your deep cleaning will likely fall under basic or major categories, which usually leads to higher out-of-pocket costs.
6. Insurance Coverage Percentage:
Here, your insurance company dictates how much cost they’ll cover for you. For instance, they may offer to cover say 50% or 80% of the cost while you will have to take responsibility for the rest uncovered percentage.
7. Location Matters:
The location you’re positioned in also affects the extent of coverage you get because different states and regions have regulations and practices that differ from place to place regarding coverage for deep cleaning.
8. Additional Costs:
You may be offered additional benefits like follow-up visits and medication coverage by some plans as regards deep cleaning. You want to be keen to seize such great advantages.
Read Also: Does Dental Insurance Cover Gum Grafts?
Average Cost Ranges For Deep Cleaning With Or Without Dental Insurance
Without insurance, the cost of deep cleaning varies based on location, severity of gum disease, and dentist fees. But generally, you can expect to pay anywhere from $300 to $800 per quadrant without insurance. A complete deep cleaning of the entire mouth can be very expensive, ranging from $1,200 to $3,200.
If you have dental insurance, you can relax a little! Most dental insurance plans cover a portion of the cost of deep cleaning, which can help reduce your out-of-pocket expenses. The typical coverage percentage ranges from 50% to 80%, depending on your plan.
For instance, if your deep cleaning costs $500 per quadrant and your insurance plan covers 80%, you would only have to pay $100 per quadrant, saving you $400 in total.
Even with insurance, it’s important to be prepared for out-of-pocket expenses.
Even with insurance, it’s important to be prepared for out-of-pocket expenses like; deductibles (the payment you must make before insurance coverage starts) and copayment; some services, such as deep cleaning, require a fixed amount of payment known as a co-pay contribution.
Finally, depending on the coverage percentage of your plan, you may still be responsible for some of the procedure costs that your plan did not cover.
Check this out: Does Dental Insurance Cover Anesthesia?
Alternatives if Your Dental Insurance Doesn’t Cover Deep Cleaning
Here are alternative ways to get covered for your deep cleaning:
- Dental discount plans
- Negotiation with your dentist
- Dental financing options
1. Dental Discount Plans:
These plans are not insurance, but they function as membership programs that offer you reduced rates on dental services, including deep cleaning. Just feel free to explore different plans and compare fees to find one that works with your budget.
2. Negotiation with Your Dentist:
You can also talk to your dentist about your financial situation and ask if they offer payment plans or discounts for deep cleaning.
3. Dental Financing Options:
For your extensive deep cleaning needs or multiple quadrants requiring treatment, consider financing options offered by dentists or specialized lending companies. Such options allow spreading out the cost over manageable monthly payments.
Read Also: Does Dental Insurance Cover Wisdom Teeth Removal?
How To Preventing the Need for Deep Cleaning
Here are some of the professional and highly recommended ways to prevent your need for deep cleaning and enhance your oral health:
- Good oral hygiene
- Regular check-ups
- Mouthwash
1. Good Oral Hygiene:
It is highly recommended globally that you brush your teeth twice a day, for two minutes each time, using a soft-bristled toothbrush and toothpaste that contains fluoride.
Your tongue also harbors bacteria, so don’t forget to clean it. It’s also important to floss once a day, gently working the floss between your teeth to remove plaque and any food particles that may have been missed during brushing.
2. Regular Checkups:
We recommend that you schedule regular checkups with your dentist every six months as it’ll serve as an early warning system for gum disease. Don’t underestimate the importance of your dentist, as they can detect and address the early signs of gum disease before it progresses and requires deep cleaning.
3. Mouthwash
Using a fluoride mouthwash can help eliminate bacteria and freshen your breath. Reach out to your dentist so he can recommend the best mouthwash for your specific needs.
Frequently Asked Questions
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Important Recommendation
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- Does Dental Insurance Cover Oral Cancer Screening?
- Does Dental Insurance Cover Root Canal?
- Does Dental Insurance Cover Cavities?
Conclusion
We hope you learned a lot from this article. As always, we have your best interest at heart, so we recommend good oral hygiene to prevent the need for deep cleaning because prevention is always the cheapest option.
If you cannot prevent it, then choose your insurance plan wisely. Thanks for your time!
Cheers!