At MiraMar Family Dental, we often see the surprise on patients’ faces when they learn their plan only covers a small portion of a complex procedure. Our goal here is to explain what dental insurance in Katy, TX typically covers, what it frequently excludes, and how to plan smartly so you can protect your smile without surprises.
Many patients walk in thinking that because they pay for dental insurance, every treatment will be fully covered. I wish it were that simple. In reality, most plans are designed to support prevention, not to pay for everything once a bigger problem shows up.
In general, plans emphasize preventive care. Most PPO dental plans cover a high percentage (sometimes 100%) of basic preventive services, such as:
These services help you stay healthy, but they don’t fix deeper issues that have already developed—that’s where coverage tends to drop off.
In my experience, dental insurance works great for staying on track with prevention, but it’s not designed to fully cover extensive restorative, orthodontic, or cosmetic care.
Here’s where confusion is most common. Many patients expect insurance to handle the expensive treatments—and often it doesn’t:
Orthodontics (braces or aligners): coverage is frequently limited to a small allowance compared with the full treatment fee.
Dental implants or some crowns: many plans exclude these entirely or apply strict limitations.
Root canal + crown: a plan may help with the root canal but not the crown that follows.
Whitening and cosmetic procedures: usually excluded because they’re not considered “medically necessary.”
On top of that, most plans have a yearly maximum (for example, $1,000–$1,500). Once you hit that cap, the plan stops paying for the rest of the year—even if you still need treatment.
In Texas, common carriers like Aetna, Cigna, Humana, and MetLife offer useful benefits, but with clear limits. It’s typical to see plans cover only a portion of treatment (often 25%–50%) and set lifetime maximums for services like orthodontics (commonly $1,000–$2,500, depending on plan and patient age). If an ortho case costs $5,000–$7,000, insurance may cover only a limited share and the remainder is out-of-pocket.
Some plans cover orthodontics only for minors and may exclude adult treatment or clear aligners (like Invisalign) as “cosmetic.” Every policy is different—so it’s important to review details before assuming full coverage. Our team can help you verify your benefits and plan the most cost-effective path.
If your dental plan doesn’t cover all the treatment you need (which is very common), don’t worry. You still have several options to make your dental care more affordable:
Up to 20% savings on selected treatments
2 dental exams and 2 cleanings per year included
No deductibles or annual maximums
Affordable monthly payments
For many families, pairing insurance with an in-house membership like MFD Membership helps smooth out costs—especially for services insurance doesn’t cover.
When insurance doesn’t cover everything, we work with CareCredit, LendingClub, Cherry, and Alphaeon so you can pay over time—sometimes with no interest promotional periods for qualified patients.
We review your insurance benefits up front so you know exactly what’s covered and what your share will be before we begin.
The best way to avoid unpleasant surprises is to prevent bigger problems. Seeing us twice a year helps catch issues early and avoid more complex—and more expensive—treatments later.
Think of dental insurance like a small umbrella: it’s great for a drizzle, but not for a storm. What matters most is understanding what’s covered, what isn’t, and what complements your plan so you can get the care you need without delay.
At MiraMar Family Dental, we’ll help you read your policy, combine the right options, and prevent unpleasant billing surprises. No one should skip necessary care due to uncertainty about coverage—there are options, and our team can walk you through them step by step.
It depends on your needs and the treatments you may need. If you mainly want cleanings and checkups, a basic PPO plan can work well. If you might need orthodontics or implants, look for broader coverage—or pair your insurance with our MFD Membership to maximize savings.
Dental insurance is preventive by design, not a comprehensive medical plan. Most policies have a yearly maximum (often $1,000–$2,000) that can be used up quickly by a single major procedure.
Absolutely. We offer financing options and an in-house membership with discounts on cleanings, fillings, orthodontics, and more.
We accept most PPO dental insurance plans. We do not work with HMO or Medicaid. For those cases, we offer a $75 evaluation visit that includes a comprehensive exam and basic X-rays. We also accept select Medicare Advantage PPO plans.
Don’t worry—we’ll review your policy with you and outline alternatives. Often, what insurance won’t cover can receive a direct discount or be financed with no-interest options for qualified patients.
No—it doesn’t replace insurance; it complements it. Insurance typically covers preventive services, while the MFD Membership adds discounts to treatments your plan may not pay for.
We treat dental emergencies even if you don’t have insurance. We’ll offer flexible payment options and special discounts for urgent care, because your immediate attention comes first.
Skipping preventive visits nearly always makes problems worse—and more expensive. A small cavity can turn into a root canal, and mild gum inflammation can progress to periodontal disease.
