What Does Dental Insurance Cover? | Medical Cover Dental

What does dental insurance cover?

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Dental insurance generally covers a portion of the cost of range of dental services from routine preventive care to dental surgery, including oral exams, cleanings, x-rays, filings, extractions, oral surgery, root canals, crowns, and implants. Depending on the plan, it might also cover orthodontics, periodontics, and prosthodontics, such as dentures.

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Dental procedures at most dental insurance companies are typically grouped into three main categories: preventive, basic and major. Many plans cover preventive care at 100%, basic procedures at up to 50-70%, and major services, such as surgery, at up to 50%. However, coverage and costs can vary depending upon the plan level you select. Many plans have caps on what they will pay during a plan year, which may increase the longer you have the plan.

There is no standard classification among insurance companies for what services are considered preventive, basic or major and insurance coverage varies. When comparing dental insurance plans, it’s important to compare what services each insurance company classifies as preventive, basic or major and what their coverages are for those classifications.

What does medical cover for dental?

It’s very common to assume that dental care is included in your medical health insurance but medical insurance typically doesn’t cover vision or dental care. Typically, the only dental treatment that medical insurance covers is treatment for serious dental injuries that occur as part of another injury or injuries that happened in an accident. You need to have secondary dental insurance to cover dental procedures that aren’t medically necessary. When you’re trying to figure out if your medical insurance will cover your dental care it’s helpful to think of your insurances as primary vs secondary insurance. Your medical care is the primary insurance that will likely only cover major damage sustained in an accident and your dental insurance is the secondary insurance that will typically cover the cost of basic dental care.

What dental procedures are covered by medical insurance?

So what dental care will medical insurance cover? What is secondary dental insurance and do I need it? If you’re in a car accident and you hit your face on the steering wheel and knock out several teeth medical insurance might pay for some of that treatment but you would need to have a dental insurance plan that covers implants to have insurance pay for the cost of replacing the lost teeth. Medical insurance may also pay for some devices that help your teeth but also have medical value like mouth guards, sleep apnea appliances, TMJ appliances, or biopsies¹. Secondary dental insurance is additional insurance that help cover things like emergencies and fill in the gaps in your existing coverage.

Medical insurance also might cover the cost of treatment for accidents that cause serious damage to your mouth or X-rays that are needed to see what damage an accident has caused².

Is dental considered health care?

Dental Insurance - what does it cover?

Even though there is a link between good health and good oral health for the purposes of health care dental care is considered separate from health care. That’s why things like dental exams, cleanings, and fillings aren’t typically covered by medical insurance. However, oral health does have an impact on your overall physical health. Infections in your mouth from broken teeth or other dental conditions can travel in your bloodstream causing serious infection in the lining of your hear called endocarditis. Bacteria from your mouth can also end up being taken into your lungs, which can cause pneumonia³.

The best way to make sure that you help maintain good oral health so that you can stay physically healthy is to brush and floss daily, get regular dental cleanings, and make sure that you are getting things like fillings or crowns when you need them⁴. Buying a good dental insurance policy can help you maintain good oral health by making dental care affordable. Some insurers, like Guardian Direct®, cover 100% of the cost of preventative dental care on some insurance plans. That means that subject to any applicable waiting period and annual maximums, you won’t pay for exams or cleanings, and you will pay reduced prices on things like extractions, fillings, root canals, and other dental procedures when using in network dentists.

Does dental insurance cover crowns?

Having a crown put on, either on a broken tooth after a root canal or put on an implant, is the most common dental procedure in the country⁵. Dental insurance usually won’t cover the entire cost of a crown. In many cases, crowns are considered a major dental service and many dental insurance plans cover 50% after a waiting period. If you suspect that you’re going to need a crown when you are buying dental insurance look for a plan that offers some coverage for major dental procedures.

Does dental insurance cover braces or Invisalign®?

Most dental insurance plans don’t cover cosmetic dentistry. They may cover whitening if it’s necessary to make a tooth match the color of your existing teeth, but in general cosmetic procedures are not typically covered. Orthodontics like braces or straighteners are considered cosmetic and many dental insurance providers won’t cover them. However, there are Guardian Direct plans that will cover a portion of the cost of orthodontics for covered children younger than 19 after a 12 month waiting period.

Does dental insurance cover wisdom teeth removal?

In many cases, dental insurance covers wisdom tooth removal, but coverage may vary depending on how complicated the tooth extraction is. Simple tooth extractions are often considered basic dental services and may be partially covered after a waiting period. Complex extractions may be partially covered after a waiting period.

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Does dental insurance dentures?

Dentures are another major dental procedure that can be very expensive. One plate of dentures can cost anywhere from $300 on the low end of the spectrum to $4000 on the high end⁶. Dentures are not something that you want to try and save money on because there is a big difference in quality between lower end dentures and higher end dentures. Always get the best dentures you can afford. Many dental insurance providers will cover a portion of the cost of dentures after a waiting period that is usually 12 months but could be longer depending on the terms of the dental policy you buy. Guardian Direct Gold and Silver plans will cover up to 50% of the cost after dentures after a 12 month waiting period. Make sure that the dental plan you choose also covers some of the costs associated with getting dentures like exams, fittings, and X-rays⁷.

Does dental insurance cover bonding?

Bonding is typically considered to be a cosmetic dental procedure and almost all dental insurers will not cover cosmetic procedures. However, you may be able to get your insurance provider to cover some of the cost of bonding if you need the bonding in order to save a tooth. For example, if you have a tooth that is chipped and not fixing the tooth would cause the tooth to be at risk for cracking or breaking then the insurance company might pay for the cost of the bonding. Check with your insurance company to see if your provider covers bonding.

Does dental insurance cover deep cleanings?

The procedure for deep cleaning teeth is called scaling and planing. Scaling and planing is often needed if you haven’t seen the dentist in a long time or if you haven’t had your teeth cleaned in a long time. Most of the time scaling and planing is done over the course of two appointments⁸.

Does dental insurance cover night guards?

Some dental insurance companies cover night guards but it’s best to check with your insurance company. If you need a night guard in order to protect your teeth or treat a condition like TMJ or Bruxism your medical insurance may cover the cost of the night guard if your dental insurance provider doesn’t. If you need any kind of customized dental appliances or equipment to combat a medical problem or something that could become a medical problem it’s a smart idea to check with your medical insurance to see if they will pay the cost for that appliance. If they won’t cover it then you can submit it to your dental insurance provider. If you have double insurance coverage one of the policies may be able to cover the cost of dental appliances.

Does dental insurance cover veneers?

Veneers, which are tiny pieces of porcelain fitted over your teeth to fix the look of your teeth⁹, are considered to be cosmetic dentistry and are not typically covered by most dental insurance providers. If you want to learn more about veneers cost you can read the article in the Guardian Direct library of resources. Guardian Direct has put together a vast library of information, insights, tips, and guides to help answer your questions like “Can I have two dental plans?” and help you learn more about dental health and dental insurance so that you will be able to make an informed decision when purchasing dental insurance for your unique needs.

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Does dental insurance cover teeth whitening?

Not in most cases, but check with your insurance company. Some insurance companies may pay for whitening in certain circumstances. Cosmetic dentistry procedures are not often covered by dental insurance. However, with a good dental insurance plan that covers preventative care and other services you can help save money on your dental care and put that money towards paying for the cosmetic dentistry that you want to have done.

*Invisalign® is a registered trademark of Align Technology, Inc.


Sources

  1. https://niermanpm.com/blog/services-to-bill-to-medical-insurance (2020), accessed June 2021

  2. https://niermanpm.com/blog/services-to-bill-to-medical-insurance (2020), accessed June 2021

  3. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475 (2019), accessed June 2021

  4. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475 (2019), accessed June 2021

  5. https://www.gotoapro.org/facts-figures/, accessed June 2021

  6. https://health.costhelper.com/dentures.html, accessed June 2021

  7. https://health.costhelper.com/dentures.html, accessed June 2021

  8. https://www.mouthhealthy.org/en/az-topics/s/scaling-and-root-planing, accessed June 2021

  9. https://www.webmd.com/oral-health/guide/veneers(2020, accessed June 2021

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.10/21)

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