First, the bad news: You’ve just learned you have a cavity. Fortunately, you also have Aetna dental insurance. And that means the filling you need will be covered by your policy, right?
Unfortunately, not always. Dental insurance waiting periods and coverage limits can interfere with your ability to get treatment when needed. Here’s a closer look at when Aetna dental insurance will cover fillings, when it won’t and what other options are available:
A Quick Primer on Cavities
Lack of improper dental care, a diet high in carbs and sugar or even just plain bad genetic luck can all cause cavities. Also called caries or even just tooth decay, cavities are tiny, permanent holes in the hard surface of a tooth.
They’re caused by plaque, a clear, sticky film which forms after eating sugars and starches. With regular dental care, plaque is typically brushed away before it can cause much damage. But after about 24 hours, plaque starts to harden into tartar, which is far more difficult to remove.
Your mouth is filled with hungry bacteria. Normally, when the bacteria feed on substances in your mouth, it’s helping keep your mouth clean. But if it feeds on plaque, it excretes a corrosive acid. This acid efficiently and effectively erodes away enamel, which is the hard, outer surface of your teeth.
Fillings are the Most Common Cavity Treatment
Left untreated, acid eventually wears through the tooth’s outer layer down to the softer layer of dentin underneath. From there, bacteria and acid can attack your pulp, a problem which is both painful and will eventually result in tooth loss.
There are three ways to treat cavities:
- Root Canals
Fillings are the most common treatment for cavities. They’re used during the initial stages of a cavity formation when the holes in the enamel are relatively shallow. Fillings repair the existing damage while preventing additional decay.
First, the dentist numbs the area with a local anesthetic. Then the decayed portion of your tooth is removed with a drill. Don’t worry! Modern techniques made the process quick and generally pain-free.
Once the decayed part is removed, your tooth will be left with a hole. A filling – as you can guess – is used to fill this space. Four types are available:
- Composite Resin
Does Aetna Dental Insurance Cover Fillings?
Generally, yes. Although specifics will vary by plan, even the most inexpensive plans typically provide at least some coverage for a basic filling. However, restrictions might apply:
Everything covered by a dental insurance policy isn’t instantly available after you make your first payment. Wait limits are fairly common.
For major procedures such as root canals and dental surgery, you might have to own the policy for a year before coverage will begin. Basic procedures, such as fillings, can have a six-month waiting period.
Aetna dental insurance doesn’t necessarily impose a six-month waiting period on fillings. Specifics will vary by policy. However, a cavity can grow significantly if left untreated for six months.
Most policies have an annual coverage limit. It varies but $1,000 to $1,500 is pretty common. Once the limit is reached, the policy won’t pay for any more procedures, even ones covered by the policy.
You can probably have a basic filling completed without reaching your annual limit. However, you’ll likely run into problems if you need several fillings or other dental work.
Type of Filling
Policies might place limits on the type of filling covered. White, composite fillings are usually considered the most natural looking, but they’re also the most expensive, so not every policy covers them. Some policies might only cover the less-expensive silver and gold fillings.
Generally, Aetna policies do cover composite fillings, but with limits on specific teeth. Composite fillings are often allowed for visible teeth near the front of the mouth, but not necessarily for those in the back of the mouth.
Most dental policies won’t cover significant dental problems you had before you purchased the policy. For example, if you’re missing a tooth, practically no policy will cover treatments such as implants, bridges or dentures.
Fillings are often covered because they’re relatively simple procedures which prevent larger problems. However, as decay worsens, different treatments are needed. Fillings are only effective against small cavities.
Is Dental Insurance the Best Option for Fillings?
Dental insurance, especially when provided by an employer, can be a great option if you have no current dental issues and only need preventative care. However, the waiting periods and restrictions do pose obstacles when treating problems you already have.
Dental discount plans are another way to save on fillings. They allow members to save between 15% and 50% on a wide range of dental procedures, including fillings with your choice of material including white composite.
Plus, discount plans have no limits on pre-existing problems. Even if you have extensive dental decay, you can still save on procedures you need. Discounts are available for you to use within about 72 hours after your first monthly payment (about $10 to $13). If you’re faced with a six-month waiting period before insurance coverage begins, choose a discount plan to get the care you need right away.
Discount plans are offered by the same major insurers, such as Aetna, who offer dental insurance. After all, insurance companies understand dental insurance isn’t for everybody. Aetna discount plans are created as a different way to save.
Don’t let a cavity go untreated for long. Avoid wait times and limits on pre-existing limits with a dental discount plan. Fillings and discount plans are a winning team.