Coverage for Cosmetic Dentistry
Dental insurance companies generally do not cover cosmetic procedures, which “[improves] the appearance of the teeth and mouth,” because they “prefer focusing on oral health and preventive services rather than elective procedures” (Susan 2011; “Cosmetic Dental Insurance”). For example, patients undergo teeth whitening/bleaching in order “to reduce staining and discoloration or simply improve the teeth based on their personal preferences” (Susan 2011). Even so, some insurance plans pay for cosmetic treatments (Susan 2011).
Dental insurance will cover some of them depending on whether the patient needs them. For instance, dental insurance would cover treatments in cases where there is “[a] chip or other damage to a front tooth” (Hall “Cosmetic Dentistry Procedures that Dental Insurance Doesn’t Cover”). Additionally, tooth caps, or crowns, “are sometimes considered cosmetic if you use them simply to cover up an unshapely tooth and make it look nicer, but they are usually not considered cosmetic if the tooth is falling apart or they need to cover the open space left by a root canal procedure” (Susan 2011). Likewise, orthodontic procedures can be categorized as cosmetic procedures since braces “straighten teeth” in order to improve the patient’s smile (Susan 2011). Though, according to an article, “Does Dental Insurance Cover Braces and Orthodontist Services?”, “For children, dental insurance for braces may be required in some states, but this does not cover every situation. For example, braces could be covered if they are necessary to improve a child’s ability to chew his food properly” (2015). Dental insurance typically does not pay for adults’ orthodontic procedures, “if the treatment is desired for purely cosmetic reasons” (“Does Dental Insurance Cover Braces and Orthodontics Services?” 2015). Patients should check if their insurance plans cover certain cosmetic procedures.
While patients may not need some of these procedures, they could enroll into insurance plans that cover the ones they want. Plans that pay for these treatments “tend to have higher premiums and deductibles, as they are the premier plans” (Susan 2011). Due to these high costs, patients should search for insurance plans that provide coverage on “the procedures [they] would like” (Susan 2011). However, according to Dr. David Hall, “an accredited cosmetic dentist,” “In order to keep costs under control, [insurance companies] will set up strict limitations on benefits” (“Cosmetic Dentistry and Dental Insurance”). For instance, an insurance company would pay for “a porcelain fused to metal crown” because it is cheaper than an all-ceramic crown, but all-ceramic crowns “perfectly [match] the [patient’s] other teeth,” while “porcelain fused to metal crowns are opaque, fake-looking, and they tend to develop a black line at the gumline after they’ve been in [the patient’s] mouth a while” (Hall “Cosmetic Dentistry and Dental Insurance”). Dr. Hall recommends that patients should choose their preferred treatment instead of allowing insurance to dictate their choices (“Cosmetic Dentistry and Dental Insurance”).
In addition to procedures that primarily focus on improving oral health, some insurance plans cover cosmetic services that not only better the teeth’s appearance, but also help patients’ dental needs.