As a patient, you want to get the most out of your dental health insurance coverage. While your expectation is reasonable, navigating what the insurance covers and does not can sometimes take time, especially regarding cosmetic dental treatments. Cosmetic dentistry enhances the appearance of your teeth and smiles. You can use them to fill unappealing gaps between the teeth, change the shape, size, and alignment of your teeth, brighten your tooth color, restore missing teeth, replace old, unappealing oral treatments, and repair cracked, broken, decayed, or chipped teeth.

Generally, insurers will cover a cosmetic procedure, provided dentists consider it restorative (a procedure necessary for medical reasons like extracting diseased teeth or repairing teeth broken after an injury). This blog post discusses standard cosmetic treatments covered by healthcare insurance.

Dental Implant

A dental implant is a medical device inserted into the patient’s jaw to replace a missing tooth. Dentists fix the artificial tooth to the jaw using a small titanium pole. The artificial tooth resembles your natural tooth. 

Your dental implant system comprises the following:

  • Implant body — A screw that dentists insert into the jawbone to replace a tooth’s root.
  • Abutment — A device is fixed to your implant body and extends via your gums to support a crown.
  • Crown — The artificial tooth attached to your abutment.

There are different categories of implants, including the following:

  • Endosteal — These implants are surgically placed into your jawbone
  • Subperiosteal implants — These are fixed under the gum patient’s gum tissue above the jawbone. They are primarily used to replace multiple teeth.

Since the procedure is cosmetic, some insurers can exclude or limit coverage. Various parts of the treatment that are partially covered include the following:

  • Tooth extraction of the damaged tooth: your dentist should pull it before placing the implant.
  • Bone grafting to reinforce your jawbone.
  • Placing the implant
  • Crown placement

Factors Affecting the Coverage Amount

When an insurance provider covers implants, they limit the coverage in many ways, including the following:

  • You must wait for a given duration after receiving insurance before the company can cover your implant.
  • Many policies have yearly coverage maximums and can also have lifetime or annual limits on implants.
  • The insurer can also set a coverage limit of ten to fifty percent for crowns and implants.

Dental Crowns

A crown is a tooth-shaped cap placed over a problematic tooth to restore its shape and size. Dentists use it to cover the damaged tooth before cementing it in place. You can use crowns to:

  • Cover an implant
  • Correct a chipped tooth syndrome
  • Protect a patient’s tooth from further wear and tear
  • Safeguard the tooth following a root canal
  • Cover a tooth after filling placement

Four crown materials categories are porcelain base metal, gold, and ceramic. Your dentist should guide you in choosing what suits your needs best.

While dental insurance firms cover getting dental crowns, there are several provisions that your insurer can use to lower your coverage amount, increasing the amount you should top up and delaying the ability to receive dental care timely.

Here is what you should know before requesting your insurer to cater to your treatment:

  • Network dentist — As with any major health insurance provider, your insurer will likely request you select a dentist from their network of dental professionals before the crown treatment. If you need a dental crown immediately or want to select your preferred dentist, your insurance provider may not pay the costs.
  • Annual limit — Suppose you have a private dental insurer, government-funded, or military coverage. In that case, many insurance firms include a yearly maximum cap that could determine how much they will cover for specific dental services within twelve months. On average, the standard annual limit is $1,500, which could make it a challenge to receive the dental procedures you need without exceeding your limit. You may stay within your annual limit if you need only crowns. Nevertheless, if you need additional dental procedures at some point, you may have to pay the remaining balance out-of-pocket.
  • Waiting duration — Finally, most insurance firms have a long waiting time before you receive a crown treatment, especially if you are a new client. The waiting period can take anywhere from twelve months to two years, which could lead to more tooth damage if you cannot receive the care you need.

Root Canal

Root canal treatment is a dental procedure to remove an inflammation or infected tooth pulp (jelly-like tooth center containing connective tissues, nerves, and blood vessels). The procedure involves cleaning, disinfecting, filling, and sealing the tooth. The treatment aims to eliminate bacteria from the infected tooth, prevent reinfection of the tooth, and save your natural tooth.

Extensive tooth damage that has reached the tooth’s outer layer can cause root canal pain. The root canal pain can also be due to chippings or cracks.

Signs that indicate you require the root canal treatment include:

  • Darkening of your tooth
  • Swelling in the gums
  • Sensitivity to cold or hot drinks
  • Severe pain in your teeth while chewing or eating

The price of obtaining the treatment hinges on the challenges of removing your root nerves and vessels. The average cost of getting a root canal is $250 and $186 per one root removal procedure and a residual tooth removal, respectively.

The amount of dental coverage you get for root canal therapy will depend on your insurance plan. Many dental insurance covers cater for a fraction of root canal treatment costs. Some insurance plans may have a waiting duration before catering for the root canal procedure’s expenses activation.

Additionally, some insurance covers can restrict the number of root canal treatments covered per annum. Before making an appointment for a root canal procedure, consult with your insurer to know what they cover and any related out-of-pocket costs.

Veneers Procedure

Veneers are artificial coverings fixed to a patient’s front tooth to enhance its appearance while maintaining a natural appearance. The dental restoration camouflages the following:

  • Too tiny teeth
  • Stains that cannot improve with teeth whitening
  • Broken or chipped teeth
  • Spaces or gaps in teeth
  • Misshapen teeth

Please note that you qualify for veneers if you do not have severe gum disease and cavities. You should first treat these oral health problems.

Veneers come in different shapes, colors, materials, or sizes. They are mainly made from resin material or porcelain and require intensive work. However, there also exist ‘’no-prep’’ veneers. Applying conventional veneers entails grinding down your tooth structure, sometimes removing enamel. While it permits proper placement, it is irreversible and can be painful. Tooth reduction hinges on the number of teeth requiring treatment and your dental issues.

The cost of veneer placement depends on factors like your veneer’s type, your dentist’s expertise, and your geographical location.

A common question among patients considering dental veneers is whether their insurance provider will cover the costs. While dental insurance plans do not cover veneer procedures, there are certain exceptions.

Some insurance plans can offer partial coverage if a dentist recommends dental veneers to treat specific oral health issues. For instance, your insurer can cover your treatment if your tooth is damaged during an accident, and your dentist recommends dental veneers as the restorative option.

Dental Fillings

Tooth fillings are used to treat cavities or tooth decay. The dentist typically removes the infection and fills the hole to prevent more damage. Dentists can also use fillings for cosmetic purposes, like covering staining or closing gaps between teeth.

There are many types of dental filling materials, including the following:

  • Silver amalgam — Silver amalgam fillings combine silver and other materials like zinc, tin, mercury, and copper. The fillings are popular because they are sturdy, durable, and more cost-effective than most alternatives. A standard silver amalgam can be effective for up to twelve years. Dental health providers find them simple to use because they are malleable. The common disadvantage of silver fillings is that aesthetically, they are unsatisfying and unsuitable for front teeth. Silver amalgam fillings can also negatively respond to temperature changes by contracting and expanding, leading to cracks in your tooth. The fluctuations can also cause a gap between the filling and the tooth, letting in food and mouth bacteria and forming new cavities.
  • Gold fillings — Gold tooth fillings are an excellent option over silver amalgam fillings. The pros of gold fillings are their strength, which can handle constant chewing pressure and are more appealing than silver fillings. However, gold dental fillings are costly and can cost about ten times more than silver fillings. Additionally, gold dental fillings require two fitting sessions with your dentist.
  • Glass ionomer fillings— Glass ionomers are primarily used for minors as their teeth change. These dental fillings mainly do not endure beyond 5 (five) years. They can emit fluoride, preventing tooth damage. Glass ionomer fillings can be more prone to fractures than other dental fillings. Additionally, these fillings cannot withstand the pressure of chewing. They are also not ideal for back teeth that receive immense pressure.

Most insurance companies cover fillings entirely or largely after dentists consider them a medical necessity. Check with your insurer whether your plan covers the filling or entire procedure. For instance, you might require an X-ray before your dentist fills your teeth. Other extra costs can stem from plaque removal and cleaning before the treatment.

Tooth Bonding

Dental bonding is a treatment when a dentist applies a tooth-colored resin material and then hardens it using a special light, bonding the material to the tooth and improving or restoring your smile.

You qualify for the procedure if you want to:

  • Repair your decayed teeth
  • Repair cracked or chipped teeth
  • Close spaces between your teeth
  • Improve the appearance of your discolored teeth
  • Make your teeth look longer
  • Change your teeth’s shape
  • Protect part of your exposed tooth’s root after gums recede

Some dentists prefer teeth bonding for minor cosmetic changes, short-term rectification of cosmetic issues, and correcting teeth in regions of low bite pressure like front teeth.

Unlike veneers, dental bonding does not require significant enamel removal, and the procedure is reversible. However, you might need a touchup after three years.

Since dental bonding can serve restorative and cosmetic purposes, insurance coverage often depends on the reason for the procedure. Determining whether insurance covers bonding involves understanding the nuances of insurance policies, communication, and research. Here are steps to know whether the procedure is covered:

  • Know why you need dental bonding
  • Analyze your insurance policy’s summary of benefits
  • Contact your insurer
  • Check for out-of-network vs. in-network providers
  • Read policy limitations and exclusions
  • Stay updated

Tooth Reshaping

Also called odontoplasty, tooth reshaping is an affordable, convenient cosmetic dentistry option that fixes misaligned, cracked, uneven, or chipped teeth.

The procedure is tailored to rectify subtle or minor teeth imperfections. It is not ideal for major dental treatments. For instance, if your teeth are severely misaligned or crooked, your dentist might recommend braces instead.

You must have healthy gums and teeth to be eligible for this procedure. It involves minimal enamel removal before lengthening or shaping your tooth.

The cost of undergoing the procedure ranges between $50 and $300. Most insurers do not cover the expenses unless you want to treat/correct a cracked tooth following trauma or an accident. It is seamless to have an insurer cover the cost. It involves the following steps:

  • Giving a physician your insurance details and then submitting a claim to your insurer.
  • Upon receiving the claim, the insurance provider will confirm whether the treatment falls in your insurance policy before making the necessary payments.

Find a Skilled Cosmetic Dentist Near Me

Cosmetic dentistry is crucial to your teeth and smile’s aesthetics, but it is often overlooked in most health insurance plans. Like most patients, you might be unsure whether your insurer covers your treatment, mainly when faced with huge dental care costs. Knowing whether your insurance provider covers your treatment option can help you manage your expenses better. Washington Dental can help explore the available options and expound on how cosmetic dentistry works in healthcare insurance plans. We are committed to ensuring you receive the insurance you need and make an informed decision. Please contact our office at 310-217-1507 to learn how we can help you.