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Dental crown cost and how dental insurance coverage can help

How dental insurance helps with the cost of crowns.

Your dentist just recommended a dental crown be put on one of your teeth. While this may not be welcome news, crowns are often recommended to protect the integrity of your tooth; delaying care today could lead to further damage costing you more in the long term, so it is best to address it as soon as possible.

Before you schedule your appointment, it is important to understand not only the purpose of a crown, but the costs involved so you can make an informed decision. Learn what crowns are, why they are needed, how much they cost, and how insurance coverage can help make crowns more affordable.

What is a dental crown?

The crown of the tooth is the visible area above the gum line, and the crowns are the part of your teeth you can see when you smile. When this is damaged, a dentist may recommend an artificial crown to act as a “cap” that protects the rest of the tooth.1  

A crown may be made of many types of materials such as porcelain, a composite resin, a combination of porcelain and metal, or a metal alloy.

Do you need a dental crown?

An artificial dental crown may be needed if you:

  • Chip a tooth
  • Develop a cavity that a filling cannot fully cover
  • Have a filling that wears down over time, causing the cavity below it to expand
  • Have severe tooth decay that weakens the enamel

Benefits of dental crowns

A dental crown can protect the tooth from further damage while restoring its look and functionality. For instance, if a tooth has decayed severely and the enamel is weakened, you may experience tooth sensitivity. A crown can act as a barrier, like the original enamel, and restore the integrity of the tooth.

Even if you don’t have a damaged tooth, you may want a crown to restore the cosmetic look of your smile such as through color-matching a discolored tooth to the rest of your teeth. Dental insurance may or may not cover the cost of a crown done for aesthetic reasons, so be sure to read your policy before pursuing this option.

What do crowns cost?

A study by the Health Policy Institute found that the average annual cost per patient for dental services was about $685 regardless if someone has insurance or not.2 Basic services such as dental cleanings are often covered with dental insurance, reducing your out-of-pocket costs. Insurance also covers some or all of the costs of procedures, such as getting a dental crown.

The cost of a dental crown can vary based on a several factors such as:

  • What your insurance covers 
  • The amount of your deductible
  • Additional work the dentist might need to perform
  • If there are other services you are receiving that day, such as a filling for a cavity

On average, the costs can range from $600 to $1,500 per crown.3

Will my insurance cover dental crowns?

To find out what kind of dental crown insurance coverage you have, review your plan summary or talk to your insurance provider. You will have to consider your deductibles and maximums, as well as any waiting periods involved after your coverage start date.

Guardian Direct® has dental insurance plan types that can help with the cost of crowns. One plan type is called a Preferred Provider Organization (PPO) plan, and the other is called a Dental Health Maintenance Organization (DHMO) plan.

Guardian Direct® PPO plans, called Guardian Dental Advantage Gold, Silver, and Bronze PPO plans, can save up to 35% off dentists’ typical charges for in-network services thanks to Guardian® 's negotiated rates. There are no waiting periods for preventive care, meaning you can have cleanings, X-rays, and exams done as soon as you become a member.

DMHO plans under Guardian® are called Guardian Managed DentalGuard® plans and are only available in some states. Guardian Managed DentalGuard® plans also come with different coverages. For instance, DHMO plans have no waiting periods and there is no maximum dollar payout for each benefit year. Services, percentages covered, and waiting periods vary, so the best way to know what is covered is to contact Guardian Direct® with your questions.

If your current dental insurance plan does not offer the coverage you need to cover the cost of a dental crown, you may still receive a discount on services from in-network providers. However, when you are shopping for dental insurance, you should be thinking of long-term needs. If a crown is something you may need and your current coverage is lacking, it may be time to find a better dental insurance plan.

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Sources:

1. https://my.clevelandclinic.org/health/treatments/10923-dental-crowns (Last accessed January 2020)
2. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_4.pdf 
3. https://www.investopedia.com/ask/answers/113015/does-dental-insurance-cover-crowns.asp (Last accessed January 2020)

 

Individual dental insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides DENTAL insurance only.

Dental provider networks vary by state, by market and by plan type

Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually.

IMPORTANT INFORMATION ABOUT GUARDIAN’S DENTALGUARD INDEMNITY AND DENTALGUARD PREFERRED PPO PLANS

Dental PPO plans provide in-network and out-of-network benefits. Use of an in-network provider may result in reduce out of pocket costs.

Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. Waiting periods may also apply for some services

Individual dental plans do not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatment to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment.

Individual dental plans limit benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic and prosthodontic services.

Listed services, exclusions and limitations do not constitute a contract and are a summary only.

IMPORTANT INFORMATION REGARDING DENTAL HMO BENEFITS

Dental HMOs provide Pre-Paid dental benefits through a network of participating general dentists and specialty care dentists. All covered services must be provided by the member’s Primary Care Dentist. Specialty care services are covered only when referred by the member’s Primary Care Dentist and approved in advance by the Dental DHMO.

Only those services listed in the Dental HMO plan are covered. Certain services are subject to annual or other periodic limitations. Where orthodontic benefits are specifically included, your policy provides for one course of comprehensive treatment per lifetime, per member. Dental HMOs do not provide orthodontic benefits if comprehensive orthodontic treatment or retention is in progress as of the member’s effective date. Listed services, exclusions and limitations do not constitute a contract and are a summary only.

Products Underwritten by Guardian Life Insurance Company of America

DENTAL PPO PLANS  Policy Form IP-DEN-16 ET. AL.

DENTAL HMO PLANS

      FLORIDA              Policy Form IP-1-MDG-DHMO-FL-OFF-17

      NEW YORK          Policy Form IP-MDG-NY-FP-OFF-17

 

Products Underwritten by Managed Dental Guard, Inc.

DENTAL HMO PLANS

      TEXAS                 Policy: IP-1-MDG-DHMO-TX-17

 

Products Underwritten by First Commonwealth Inc. through its Illinois subsidiaries*

DENTAL HMO PLANS

      ILLINOIS             Policy: IP-FCW-DHMO-IL-17

*First Commonwealth Insurance Company — (IL), First Commonwealth Limited Health Services Corporation — (IL), First Commonwealth of Illinois, Inc.

 

Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers

 

 

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.
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