Ameritas dental insurance plans are designed primarily to cover preventive care and medically necessary dental treatments. However, when it comes to cosmetic dentistry, coverage can be limited. According to Ameritas’ policy guidelines, services considered purely cosmetic are generally excluded from coverage unless they are required as a result of an accident or are deemed medically necessary.
Disclaimer:
Pacific Dental & Implant Solutions is not an insurance provider, and all information provided regarding dental coverage is based on our experience working with these plans. Plan details, coverage limitations, and benefit structures can change at any time. While our Billing department is happy to work with you on maximizing your plan coverage and benefits, we encourage all patients to refer to their specific plan documentation or contact your dental insurance provider directly for the final determination regarding coverage. Insurance verification by our team is provided as a courtesy, but ultimate responsibility for understanding your benefits lies with you as the policyholder.
Ameritas Dental Coverage Overview
As an in-network provider for Ameritas dental insurance in Honolulu, Pacific Dental & Implant Solutions is committed to helping patients maximize their dental benefits and understand their coverage options. Our experienced team works directly with Ameritas to ensure seamless billing and comprehensive care for our patients.
Want help understanding your exact coverage and benefits?
Schedule a free insurance verification with our team, and we’ll break down your specific Ameritas Dental benefits before you begin treatment.
Network Status
Pacific Dental & Implant Solutions is a fully credentialed Ameritas participating provider, which means our patients enjoy significant advantages when using their Ameritas dental insurance. By choosing our practice, patients benefit from:
- Streamlined claims processing
- Negotiated in-network rates
- Direct insurance verification
- Simplified out-of-pocket cost calculations
Our team can quickly verify your specific Ameritas plan details and help you understand your coverage before any procedure, ensuring transparency and helping you make informed decisions about your dental care.
Coverage Limits
Ameritas dental plans offer varying levels of coverage with annual maximums ranging from $1,500 to $3,000 depending on your specific plan. Our practice assists patients in understanding their unique coverage, including:
- Preventive services typically covered at 80-100%
- Basic procedures often covered at 80-90%
- Major treatments usually covered at 20-50%
- No waiting periods on most preventive services
We recommend scheduling a pre-treatment consultation where our insurance specialists can provide a detailed breakdown of your expected coverage and potential out-of-pocket expenses.
Waiting Periods
Ameritas dental plans have no waiting periods for most services, which is a significant advantage for patients seeking immediate care. This means:
- Preventive services are available immediately with no waiting period
- Basic and major procedures can be scheduled without delays
- Treatment can begin as soon as your plan is active
Our patient care coordinators can help you develop a strategic treatment plan that aligns with your insurance benefits and oral health needs.
What Cosmetic Dental Procedures Does Ameritas Dental Insurance Cover?
Ameritas dental insurance provides targeted coverage for dental procedures with varying levels of benefits across different plan types (PrimeStar Lite, PrimeStar Complete, and PrimeStar Boost). Understanding your specific plan’s details is crucial for maximizing your dental care coverage when considering cosmetic treatments.
Dental Implants
Ameritas dental plans offer coverage for dental implants under their PrimeStar Complete and PrimeStar Boost plans, categorized as a Major (Type 3) service. Coverage is typically provided at 50% after your deductible is met. The PrimeStar Lite plan does not include implant coverage. Annual benefit maximums apply, with PrimeStar Complete offering up to $3,000 and PrimeStar Boost offering up to $2,000 in annual benefits. This coverage helps make implant treatment more financially accessible for patients missing teeth who want a permanent solution.
Dental Crowns
Crown coverage through Ameritas dental plans is available across all plan types as a Major (Type 3) service, though coverage percentages vary. All plans provide some level of coverage for crowns when they are medically necessary to restore damaged teeth. Coverage is typically at 20% for PrimeStar Lite and 50% for both PrimeStar Complete and PrimeStar Boost plans after your deductible. If crowns are placed purely for cosmetic reasons, coverage may be limited or denied. Additionally, frequency limitations apply, typically limiting replacement to once every five years per tooth.
Dental Bridges
Ameritas provides coverage for bridges as a Major (Type 3) service across all its dental plans. Similar to crowns, bridges are typically covered at 20% under PrimeStar Lite and 50% under PrimeStar Complete and PrimeStar Boost after meeting your deductible. Coverage is generally provided when bridges are needed to replace missing teeth and restore function, rather than for purely aesthetic purposes. Frequency limitations apply, typically allowing replacement once every five years.
All-On-Four
Ameritas dental insurance provides partial coverage for All-on-4 implant solutions through their PrimeStar Complete and PrimeStar Boost plans. The implant portions are categorized as Major (Type 3) services and typically receive 50% coverage after meeting your deductible, while the prosthetic portion (denture) is also covered as a Major service. The PrimeStar Lite plan does not cover implants. Due to the comprehensive nature of this treatment, costs often exceed annual maximum benefits ($3,000 for Complete and $2,000 for Boost plans). Our financial coordinators can help develop a treatment plan that maximizes your benefits, possibly splitting treatment across benefit years to utilize multiple annual maximums for this life-changing procedure.
How to Use Your Ameritas Dental Insurance at PDIS
Pacific Dental & Implant Solutions provides comprehensive support for patients navigating their Ameritas dental insurance benefits, ensuring a transparent and straightforward approach to understanding and maximizing your coverage.
Verification Process
Our dedicated insurance team conducts a comprehensive verification of your Ameritas dental benefits before your initial appointment. We systematically review your specific plan type, examining the nuanced details of your coverage, including annual maximums, service limitations, and potential benefit exceptions. Our verification process involves detailed analysis of your plan’s specific provisions, such as copayment structures and service category coverage. We carefully document your current benefits, ensuring you have a complete understanding of your insurance support before any treatment begins.
Pre-authorization Requirements
Ameritas dental plans may require prior authorization for several critical dental procedures, including certain major treatments. Our experienced team manages the entire pre-authorization process, submitting comprehensive documentation that includes clinical records, radiographs, and detailed treatment plans demonstrating medical necessity. We handle all communication with Ameritas, preparing and submitting the required documentation to ensure proper processing. Our proactive approach typically provides you with clear insight into your expected coverage and potential out-of-pocket expenses before treatment begins.
Coverage Tiers and Network Details
As a fully credentialed Ameritas participating provider, Pacific Dental & Implant Solutions offers patients significant advantages through our in-network status. Depending on your specific Ameritas plan, coverage varies across different service categories:
- Preventive (Type 1): Up to 100% coverage
- Basic (Type 2): 80-90% coverage
- Major (Type 3): 20-50% coverage
Our office handles all claims submission directly with Ameritas, ensuring a streamlined process that minimizes administrative burden for our patients. We work diligently to help you understand the intricate details of your dental insurance, providing transparent guidance to help you maximize your available benefits.
Understanding Your Out-of-Pocket Costs with Ameritas Dental Insurance
Pacific Dental & Implant Solutions is committed to helping patients understand the financial aspects of their Ameritas dental insurance coverage, ensuring transparency and minimizing unexpected expenses.
Deductibles
Ameritas dental plans feature a consistent deductible structure across their various plan types:
- All plans include a modest annual deductible of $50 per benefit year that applies to all services
- This deductible is per person and does not vary based on the type of service
- Our insurance specialists carefully verify your specific plan’s deductible requirements, ensuring you understand exactly how these costs will be applied to your treatment
- For patients with multiple dental insurance plans, we can help coordinate benefits to potentially reduce your out-of-pocket expenses
Copayments and Coinsurance
Ameritas dental insurance utilizes a structured coinsurance system that varies by plan type and service category. Typically, patients can expect the following coinsurance ranges:
- Preventive services: 0-20% patient responsibility
- Basic procedures: 10-20% patient responsibility (PrimeStar Complete offers the lowest patient costs)
- Major services: 50-80% patient responsibility depending on plan type
The exact percentage depends on your specific plan type, with PrimeStar Complete generally offering more comprehensive coverage compared to PrimeStar Lite, while PrimeStar Boost offers unique benefits for cosmetic and orthodontic care. Our team provides a detailed breakdown of your expected out-of-pocket costs before any treatment, helping you make informed decisions about your dental care.
Annual Maximums
Ameritas dental plans offer different annual maximum benefits across their plan options:
- PrimeStar Lite: Up to $1,500 per benefit year
- PrimeStar Complete: Up to $3,000 per benefit year
- PrimeStar Boost: Up to $2,000 per benefit year
Our insurance coordinators specialize in helping patients maximize their annual benefits, providing strategic treatment planning that optimizes your insurance coverage while addressing your comprehensive dental health needs. For cosmetic procedures not fully covered by insurance, we offer various payment options to help make your desired treatment accessible.
Next Steps: Schedule Your Consultation
Ready to explore your cosmetic dentistry options with Ameritas Dental? Schedule a consultation below. When you visit, please bring along your insurance card and a valid photo ID. We also recommend preparing a list of your cosmetic concerns and bringing any previous dental records you may have available.
Having these materials ready will help us provide the most comprehensive evaluation of your needs and insurance coverage. We look forward to serving you soon!