Dental crowns are a common dental procedure that involves covering a damaged or decayed tooth with a protective cap. Many people wonder if dental crowns are covered by their medical insurance. In this article, we will explore this question in detail and provide information on various aspects related to dental crowns and insurance coverage.
1. Understanding Dental Crowns
Dental crowns are prosthetic devices made from various materials, such as porcelain, ceramic, metal, or a combination of these. They are used to restore the shape, size, and strength of damaged teeth. Dental crowns can be recommended for various reasons, including:
- Tooth decay that cannot be treated with a filling
- Cracked or fractured teeth
- Large fillings that need reinforcement
- Teeth that have undergone root canal treatment
Getting a dental crown involves multiple steps, including tooth preparation, taking impressions, and placement of the crown. The procedure is usually performed by a dentist or a prosthodontist.
2. Types of Dental Insurance
When considering the coverage for dental crowns, it is important to understand the different types of dental insurance plans. Dental insurance can be categorized into three main types:
a) Dental Discount Plans: These plans offer discounted rates for dental treatments, including dental crowns. However, the entire cost of the crown may not be covered, and you may still need to pay a significant portion of the expense.
b) Dental Health Maintenance Organization (DHMO) Plans: DHMO plans provide coverage for a range of dental services, including dental crowns. However, you will need to visit dentists within the plan's network.
c) Dental Preferred Provider Organization (DPPO) Plans: DPPO plans give you the flexibility to choose any dentist, even those outside the network. Dental crowns are typically covered under DPPO plans, but the coverage level and reimbursement rates may vary.
3. Factors Affecting Insurance Coverage
The coverage for dental crowns can vary depending on several factors. These factors may include:
- Type of dental insurance plan you have
- Your specific insurance policy and its terms
- Reason for getting a dental crown (e.g., decay, fracture, cosmetic purpose)
- Location and provider of dental services
It is essential to review your insurance policy and contact your insurance provider to understand the exact coverage for dental crowns.
4. Out-of-Pocket Costs
Even with insurance coverage, you may still have some out-of-pocket costs for dental crowns. These costs may include:
- Co-payments: Depending on your insurance plan, you may be required to pay a fixed amount or a percentage of the total cost of the crown.
- Deductibles: If your insurance plan has a deductible, you will need to pay it before your insurance coverage kicks in.
- Annual Maximums: Some insurance plans have annual maximums, which limit the amount of coverage you can receive in a year. If your crown exceeds this limit, you will be responsible for the additional cost.
The average cost of a dental crown can range from $800 to $1,500, with variations depending on factors such as material used and the complexity of the case.
5. Cosmetic Dental Crowns
While medical insurance may cover dental crowns for functional reasons such as decay or fractures, coverage for cosmetic dental crowns can be more limited. Insurance providers often consider cosmetic crowns as elective procedures and may not provide full coverage. It is advisable to check with your insurance provider to understand the coverage for cosmetic purposes.
6. Pre-Authorization and Documentation
Some insurance plans may require pre-authorization or pre-certification before getting a dental crown. This involves submitting necessary documentation, such as X-rays and treatment plans, to your insurance provider for approval. Failure to obtain pre-authorization may result in reduced or denied coverage.
7. In-Network vs. Out-of-Network Dentists
The coverage for dental crowns may vary depending on whether you choose an in-network or out-of-network dentist. In-network dentists have pre-negotiated rates with insurance providers, resulting in potentially lower out-of-pocket costs for you. If you opt for an out-of-network dentist, the coverage and reimbursement rates may be lower.
8. Alternative Treatment Options
If dental crowns are not covered by your medical insurance or if you face significant out-of-pocket costs, you may consider alternative treatment options. These alternatives may include:
- Dental Veneers: Veneers are thin shells placed on the front surface of teeth to improve their appearance. They are often used for cosmetic purposes but can also address minor tooth damage.
- Dental Bonding: This procedure involves applying tooth-colored resin to the damaged tooth and reshaping it to restore its appearance and function.
- Dental Bridges: Bridges are used to replace missing teeth and can also provide some protection to the adjacent teeth.
It is important to consult with your dentist to determine the best treatment option based on your specific oral health condition and insurance coverage.
9. Frequently Asked Questions
Q: Will my medical insurance cover dental crowns if I have a dental emergency?
A: Medical insurance may provide coverage for dental crowns in case of a dental emergency caused by an accident or injury. However, this varies depending on the insurance policy, so it is best to check with your provider.
Q: Can I upgrade to a different type of crown if I am willing to pay the difference in cost?
A: Some insurance plans may allow you to upgrade to a different type of crown, but you may need to pay the additional cost out of pocket.
Q: Does Medicare cover dental crowns?
A: Medicare generally does not cover dental crowns unless they are necessary for another covered medical procedure, such as jaw reconstruction after an injury.
10. References
1. American Dental Association -
2. Mayo Clinic -
3. Dental Insurance Shop -
