Posted by Are you stuck wondering whether dental insurance covers X-rays? Relax you’re not alone. Studies have shown that around 70% of dental visits require at least one X-ray and the average cost of bitewing X-rays is about $50-$75 while panoramic X-rays cost between $150-$250.
We have also observed that most adults who go for dental care need a bitewing X-ray every 6 months while some others need panoramic X-rays only every 3-5 years. But will you bear the full cost or will your dental insurance cover the cost of x-rays?
Breathe in, we have the answer you desire as well as all the information you need as regards dental insurance and how it covers X-rays.
Let’s get started already!
Table of Contents
Does Dental Insurance Cover X-rays?
Yes, Dental insurance covers X-rays in most cases. Typically, Preventive X-rays are covered fully which means you get 100% coverage or at least a partial coverage say 50%-80%. Whether you get full or partial coverage depends on two factors which are the type of X-rays and the specifics of your plan.
It is important you understand that the exact amount of coverage you get depends on your specific plan and limitations can vary depending on the policy your plan operates.
You also have to note that dental insurance usually allows a certain number of X-rays per year or coverage period.
Below are the common limits:
- Bitewings: Every 6 months
- Periapical: As needed
- Panoramic: Every 1-3 years
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How Does Dental Insurance Cover X-rays Based on The Type of X-ray?
The type of X-ray you require determines how much coverage your plan offers for X-rays.
Before we proceed let’s understand the three main types of X-rays:
- Bitewing X-rays:
- Panoramic X-rays:
- Cephalometric and Other Specialized X-rays:
- CBCT (Cone Beam Computed Tomography):
1. Bitewing X-rays:
They focus mainly on the crowns and roots of your teeth which are located in your lower jaw and molars. Bitewing X-rays are considered preventive X-rays by most insurance plans and therefore you get 100% coverage. They’re usually covered fully with some plans requiring a $5 copay.
2. Panoramic X-rays:
Panoramic X-rays give a comprehensive view of your entire upper and lower jaw, teeth, sinuses, and jaw points all in one image. Most dental insurance plans cover them partially or say 50%-70% or you may need to get a pre-authorization before you’re covered. It is often used for diagnoses like impacted wisdom teeth or jawbone issues.
3. Cephalometric and Other Specialized X-rays:
They show a side profile of your face, jaw, and teeth and it is mainly used in orthodontics to access your jaw alignment and view bite relationships.
It is often considered a part of orthodontic treatment and can only be covered if your plan makes room for coverage for orthodontic treatment.
4. CBCT (Cone Beam Computed Tomography):
Gives a 3D image of your jaw and teeth, and it is best used for complex oral issues like abscesses or impacted teeth. Due to its advanced technology, the cost can be significantly higher than panoramic X-rays.
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Factors Affecting Dental Insurance Coverage For X-rays
We have established that dental insurance covers X-rays now let’s explore the factors that affect the extent you’re covered for X-rays. These factors include:
- The Type of Plan
- The Type of X-rays You Need
- Pre-existing Conditions
#1. The Type of Plan
There are three main types of dental insurance plans and the level of coverage each one offers for X-rays varies.
Let’s delve into these three categories of plans and see how they affect your dental insurance coverage for X-rays:
- PPO (Preferred Provider Organization):
PPOs offer you the best benefits of all three plans. With this plan, you enjoy the freedom of choosing your dentist, whether in-network or out-of-network. PPOs often offer you 100% coverage for preventive X-rays like bitewing and panorama if you choose in-network dentists.
If you decide to go for out-of-network dentists, you may get lower coverage for x-rays, and co-pays or coinsurance may be required from you.
- HMO (Health Maintenance Organization):
HMOs demand that you stick with in-network dentists for you to maximize your coverage for X-rays. In this plan, you get excellent coverage for preventive X-rays usually 100% coverage but that is if you stick with in-network dentists.
But you are not given any option for out-of-network dentists. They’re typically unavailable or you get a minimal option for it. You can predict the cost of HMOs because your choice here is limited. You may not be covered if you switch to dentists outside their network.
So generally, PPOs typically offer more flexibility and potentially higher coverage than HMOs.
- DPO (Dental Preferred Organization):
DPO plans offer you a network of dentists and specialists that focus on dental care. The coverage you’re likely to get for preventive X-rays is usually good with this plan though it may come in varying percentages depending on the plan.
Specialized X-rays may cost you higher co-pays or coinsurance. With the DPOs you can access specialists at a reasonable cost but you might face some network limitations.
#2. The Type of X-rays You Need
Whether your dental insurance plan covers X-rays and to what extent depends on the specific type of X-ray you need and how your plan classifies it.
Based on the criteria there are two main classes:
- Preventive and Diagnostic X-rays.
Most dental insurance plans cover preventive X-rays such as bitewing X-rays and panoramas fully because they help to detect dental issues early enough enabling even insurance companies to curtail the cost of covering more complex dental issues in the future. You are not the only one looking out for your pocket, your insurance provider is too.
Depending on your plan coverage might vary, but many plans actually offer 100% coverage for preventive X-rays.
Though insurance companies offer you coverage for preventive X-rays how often you are covered may be limited. Meanwhile, see how often dental insurance covers your X-rays.
For instance, bitewing X-rays might be covered every 6 months while panoramas may be covered every 3-5 years. If you exceed this limit you might be responsible for the cost of subsequent x-ray services. Check your benefits booklet or contact your insurance provider to confirm these details.
- Diagnostic X-rays:
Compared to preventive X-rays, it is less likely for your insurance to cover diagnostic X-rays.
Some plans may offer you coverage for diagnostic x-rays which are important to diagnose some specific dental problems but others may only offer to cover a part of the cost for you.
At the same time, you take responsibility for what’s left or you may be required to get pre-authorizations before you’re offered coverage at all.
If your case requires orthodontic treatment or wisdom teeth evaluation which requires you to get more specialized and complex X-rays such as cephalometric or CBCT scans your coverage might be different. Prepare yourself for co-pays or coinsurance because most likely you will be taking a portion of the cost.
#3. Pre-existing Conditions:
Dental insurance providers usually have a different approach to X-ray coverage for people who come with pre-existing conditions. Let’s take a look.
- Waiting Periods:
Some plans have a waiting period of 6 months before covering certain pre-existing conditions. X-rays related to these conditions may not be covered during the waiting period.
- Specific Exclusions:
Many policies usually exclude coverage for certain pre-existing conditions like missing teeth or previous dental work.
- Limited Coverage:
Even if the dental plan covers X-rays, coming with pre-existing conditions might have lower coverage percentages than the usual preventive care X-rays.
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How to Maximize Your Dental Insurance Coverage For X-rays
Below are proven tips on how to use your dental insurance plan to your advantage:
- Understand Your Plan
- Make your Dentist Your Counsellor
- Consult Your Insurance Provider
- Choose in-Network Providers
- Take Advantage of Preventive Care
- Use your Negotiation power and Explore Alternatives
1. Understand Your Plan
To make the most of your plan regardless of the one you have at your disposal you must first pick your insurance plan booklet and find out what it says about the benefit you stand to get from it.
Pay closer attention to words like Preventive care benefits, type of coverage, x-rays, frequency, and limitations.
You often get 100% full or partial coverage for routine x-rays. If you need additional X-rays for specific treatments, you may be covered by higher tiers of your plan. Also make sure you scrutinize details such as limitations, frequency, and waiting periods.
2. Make your Dentist Your Counsellor
Ensure you have a transparent conversation with your Dentist.
Let him know of your concerns, if you feel pain, or if there is an upcoming procedure that demands you get an x-ray. Discuss with your dentist to find out if there are less expensive X-ray types that could come in handy.
Your dentist gives the best advice and a clear understanding of how much you’ll pay based on your plan and your dentist’s fees.
3. Consult Your Insurance Provider
You don’t have to wait until unexpected expenses surprise you before contacting your insurance provider. Perhaps your type of plan may have an advantage you’re not even aware of. You’ll never know until you ask relevant questions. Are x-rays covered, what types of x-rays are covered, are they covered, or are you to expect co-pays and deductibles, are there pre-authorization requirements?
Armed with all of this information you’re sure to make better-informed decisions that help you use your plan to your advantage.
4. Choose in-Network Providers
If you want to reduce or totally avoid co-pays, deductibles, and coinsurance costs then make in-network dentists your best friends. Out-of-network dentists always mean you should expect more expenses.
5. Take Advantage of Preventive Care:
Your best bet as always is regular checkups. Fortunately, you can get preventive X-rays at 100% coverage, so you use the opportunity and regularly check to detect problems early before they become complex issues that will require more extensive diagnostic X-rays that will cost you more down the line.
6. Use your Negotiation power and Explore Alternatives
Speak directly with your dentist and bargain for a Lower fee especially if you need diagnostic x-rays which may require a higher Out-of-Pocket cost. Look out for alternative options if your current does not cover you for X-rays.
Expenses to Expect Even When your Insurance covers X-rays.
-
Copays:
Co-pay is a flat fee you pay before your insurance steps in to cover the rest. For instance, you may required to pay a $20 co-pay for bitewing and then your insurance covers the rest no matter the amount.
-
Coinsurance:
Coinsurance comes in when you need more expensive services like panoramic X-rays. Here you pay a percentage of the approved cost instead of a fixed fee.
For example, your plan may cover 80% while you’re responsible for 20%.
-
Deductibles:
Deductibles are specific amounts you have to pay before your insurance kicks in to pay for the remaining cost. You may not have to worry about Preventive care X-rays busy for diagnostic X-rays deductibles may most likely be required of you.
For instance, if your deductible is $100 and you need a complex scan like CBCT which costs $350. You’d first have to pay the $100 before your insurance comes in to cover the remaining $250.
Proven Alternatives IF Your Dental Insurance Plans Does Not Cover X-rays
If you have limited coverage or no coverage at all for X-rays you don’t need to worry.
Here are some other ways you can access affordable X-rays:
- Find Free or low-cost dental clinics
- Visit Federally Qualified Health Centers
- Dental Schools and Hygiene Programs
- Dental Discount Programs
#1. Find Free or Low-Cost Dental Clinics:
You can get free or low-cost dental services including basic x-rays from many communities if you’re found eligible. Get in touch with your local health department or search online to find free dental clinics near you to discover one in your area.
#2. Visit Federally Qualified Health Centers (FQHCs):
These are government-funded centers that provide you with comprehensive healthcare services which includes dental care. If you’re eligible, you get such services including x-rays at reduced rates. To find the FQHCs in your area go through the health resource website:
#3. Dental Schools and Hygiene Programs:
You can also get low-cost or free dental care including x-ray services from dental schools and hygiene programs. These services are usually offered to the public as part of student training. Make more inquiries to find out if you can benefit too.
#4. Dental Discount Programs:
Use the services of the National Association of Dental Plans (NADP) to your advantage. They offer discounted dental services which also include x-rays to members. This kind of program is a good option for you if you don’t have a dental insurance plan or yours does not cover X-rays.
Frequently Asked Questions
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Important Recommendation
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Conclusion
We have seen that most dental insurance plans do cover X-rays, especially the bitewings and periapicals that are your regular dental checkup packages.
Now you have the right knowledge concerning your dental X-rays, Go for it!
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