Dental Procedures Covered by Medical Insurance

Unlike dental insurance, medical insurance generally doesn’t cover routine dental care like cleanings, fillings, or X-rays.

However, it may cover certain procedures deemed medically necessary to treat a condition affecting your overall health.

Here’s a breakdown of the types of dental work medical insurance might cover:

• Medically Necessary Procedures: Medical insurance might cover dental procedures if they are deemed essential for treating a medical condition. Examples include:
  • Oral surgery for facial trauma: If you suffer from facial fractures or require surgery to address a severe infection, your medical insurance may cover the dental work involved.
  • Surgery for oral cancer: This includes removing cancerous tissue and reconstructing the jaw or mouth.
  • Treatment of sleep apnea: If a custom-made mouthguard is needed to treat sleep apnea, medical insurance might cover it.
  • Dental procedures related to a medical condition: If a dental procedure is necessary to manage a medical condition, such as a heart condition, that makes a routine dental cleaning too risky, medical insurance may be involved.
• Procedures Following an Accident or Injury: If you experience an accident or injury that damages your teeth or jaw, medical insurance might cover the procedures needed to repair the damage.
• Biopsies: If a small sample of tissue from your mouth is needed for a biopsy to diagnose cancer or another condition, your medical insurance may cover it.
• Anesthesia: If anesthesia is required for a medically necessary dental procedure, your medical insurance might cover the cost.

Understanding Medical Insurance

Medical insurance, also known as health insurance, is a financial product offered by insurance companies that helps pay for medical expenses.

These expenses can include doctor visits, hospital stays, surgeries, medications, and sometimes, preventive care.

Medical insurance plans vary significantly, with different coverage levels, deductibles, copays, and out-of-pocket maximums.

• Deductible: This is the amount you must pay out of pocket before your insurance starts covering costs.
• Copay: This is a fixed amount you pay for certain covered services, such as a doctor’s visit.
• Out-of-pocket maximum: This is the maximum amount you will have to pay for covered services in a year.

Pros and Cons of Using Medical Insurance for Dental Procedures

Pros:

• Reduced Cost: Medical insurance can significantly reduce the cost of a medically necessary dental procedure.
• Convenience: Using your existing medical insurance can streamline the billing process.

Cons:

• Limited Coverage: Medical insurance typically only covers a narrow range of dental procedures.
• Higher Out-of-Pocket Costs: Medical insurance plans often have higher deductibles and copays compared to dental insurance.
• Pre-approval Process: Getting pre-approval from your insurance company can add extra time and hassle to the process.

Alternative Options for Dental Procedure Coverage

If your medical insurance doesn’t cover your dental needs, there are alternative options to consider:

• Dental Insurance: Dental insurance is specifically designed to cover preventive and restorative dental care. It typically has lower deductibles and copays compared to medical insurance. Many employers offer dental insurance as part of their benefits package, or you can purchase a separate dental plan from an insurance company.
• Dental Savings Plans: These are not insurance plans, but rather memberships that offer discounts on dental services from participating providers.
• CareCredit: CareCredit is a healthcare credit card that can be used to finance dental procedures.
• Charities and Dental Schools: Some charities and dental schools offer free or low-cost dental care to eligible individuals.

Factors to consider about dental procedures that are covered by medical insurance

• Plan Specificity: Every medical insurance plan is different. What’s covered under one plan might not be covered under another. It’s crucial to carefully review your plan documents or contact your insurance provider to understand the specifics of your dental coverage.
• Pre-approval: In some cases, your doctor or dentist may need pre-approval from your insurance company before performing a procedure to ensure it’s considered medically necessary.
• Out-of-pocket Costs: Even with medical insurance coverage, you might still have out-of-pocket costs such as deductibles, copays, and coinsurance.