You’ve noticed a crack or large filling on a back tooth, and you’re exploring options. Onlays cover more area than fillings, but onlays can cost more. You’ve likely heard of a crown, but how about something in between? Onlays give you strength and a natural look. And with aetna coverage for dental onlays you might pay less than you think. In this article, you’ll learn what onlays are, how Aetna typically covers them, and how to plan for any out-of-pocket costs.
Key takeaways
- Onlays are a midlevel restoration that protect cusps and preserve more tooth than crowns
- Aetna usually considers onlays major restorative care, covering around 50% after deductible
- Check your plan’s annual maximum, waiting periods, and coinsurance before you schedule
- Find an in-network dentist to lower your share of the bill
- Plan your visits, get preapproval, and follow aftercare tips to make your onlay last
Know dental onlays
What are onlays
A dental onlay is a custom-made restoration that fits over one or more cusps of a tooth. It’s bigger than a filling, but smaller than a full crown, so you keep more of your natural tooth. A lab technician molds your onlay from materials like porcelain or composite resin, then your dentist bonds it to the prepared tooth.
Benefits of onlays
- Increase tooth strength by up to 75% compared to filling materials
- Preserve healthy tooth structure because you remove less enamel than for a crown
- Offer natural aesthetics, matching your tooth color
- Last up to 20 to 30 years with proper care
Explore aetna coverage for dental onlays
Aetna coverage categories
Onlays typically fall under major restorative services, so they’re covered at your plan’s major restoration level. That usually means you pay coinsurance—often around 50%—after you meet your annual deductible. You can see how other services stack up when you review aetna covered restorative dental services.
Waiting periods and deductibles
Most Aetna plans have a waiting period of 6 to 12 months for major work, including onlays. You’ll also need to meet your annual deductible, which can range from $50 to $100 per person. After that, your plan pays its share, and you’re responsible for the rest.
Verify your plan details
Review your benefit booklet
Your benefit booklet lists the exact coverage percentages, deductibles, and annual maximums. Look for the section on major restorative care to confirm the coinsurance rate for onlays.
Contact member services
If the booklet isn’t clear, call Aetna member services. Have your plan ID handy and ask about onlay coverage, waiting periods, and any limitations. You can also compare similar policies, like bcbs covered dental inlays and onlays, to see how they differ.
Estimate your out-of-pocket costs
Calculate deductible and coinsurance
- Determine your annual deductible
- Find out the plan’s coinsurance rate for onlays
- Multiply your dentist’s fee by that percentage
- Subtract any deductible already met
Compare materials and lab fees
Porcelain onlays often cost more upfront than composite resin, but they may last longer. Gold onlays can be pricier still, but they’re very durable. Talk to your dentist about lab fees and material costs so you can budget.
| Material type | Typical coverage | Patient share after deductible |
|---|---|---|
| Composite resin | 50% | 50% |
| Porcelain | 50% | 50% |
| Gold | 50% | 50% |
Note that coverage percentages may vary by plan year, and annual benefit limits apply.
Choose the right provider
Find in-network dentists
You’ll save when you pick an in-network dentist, since they’ve agreed to Aetna’s negotiated fees. Use Aetna’s online directory to search by specialty and location.
Consider specialist options
If you have complex decay or need more conservative prep, you might see a restorative specialist. Concierge Dental Group in Western New York offers personalized care if you prefer a boutique experience.
Prepare for your procedure
Get preapproval if needed
Some plans require preauthorization for major restorations. Your dentist sends X-rays and a treatment plan to Aetna, which confirms coverage levels before you sit in the chair.
Follow aftercare guidelines
After your onlay is placed, avoid hard or sticky foods for 24 hours. Maintain good oral hygiene and visit your dentist for cleanings every six months to help your restoration last.
Next steps
Now that you know how onlays work and what Aetna covers, it’s time to check your plan details. Call member services or log in to your Aetna account to verify your benefits. Then, schedule a consultation with an in-network restorative dentist and get ready to restore your smile with confidence.
