Posted by Are you confused about dental medication coverage? Or are you asking, does dental insurance cover medication? Recent studies have shown that over 40% of patients are unsure if their dental insurance covers oral health medication.
In this article, we have demystified dental insurance coverage for some medications like antibiotics, fluoride treatments, pain relievers, & others. We will also help you understand how medication coverage can be possible with insurance and how best to use insurance for medication coverage.
Here we go!
Table of Contents
Does Dental Insurance Cover Medication?
To a large extent dental insurance covers medications. The range of medical coverage may differ based on; the type of insurance plan, medication type, deductible and copays, pre-authorization, and network/ in-network providers.
Let’s look at these points quickly.
Dental Insurance Coverage Based on Medication Type
The type of medication you are to take affects how much coverage you can obtain for your medications.
Here are some types of medications and how dental insurance coverage works for them:
- Fluoride Treatments
- Oral Hygiene Package
- Pain Relief Meds
- Antibiotics
- Anti-Fungals
- Dry-Mouth Meds
- TMJ (Temporomandibular Joints) Disorder Medications
#1. Fluoride Treatments:
Professional fluoride treatments like foams, gels, and varnishes, do not only strengthen your teeth but also prevent cavity disease. Luckily, they are completely covered by dental insurance plans, especially for children and teenagers.
So enjoy your next in-office applications with no worries over cost.
#2. Oral Hygiene Package:
Dental insurance plans cover things like mouthwash, fluoride toothpaste, and dental floss as part of the preventive care package. All you have to do is to ensure that your plan is one of the many that allows these under their preventive care umbrella. Then go right ahead and stock up!
#3. Pain Relief Meds:
Some dental procedures leave you with a lot of pain. Thankfully, dental insurance has you covered on over-the-counter pain relief meds like ibuprofen and acetaminophen. Note that these medications have to be recommended by your dentist.
#4. Antibiotics:
Bacterial infections are never good. Luckily, dental insurance plans provide coverage for antibiotics that treat such conditions as gum disease, abscesses, and post-surgical infections.
Antibiotics only target bacterial treatment, so you have to be sure what your condition is to get adequate coverage for your treatments.
#5. Anti-Fungals:
Fungi may not be as popular as bacteria, nevertheless, it can be disastrous to your health. The good news is that dental insurance also has you covered for any medication antifungal medication prescribed by your dentist.
Children and individuals with a compromised immune system, stand a higher chance of obtaining coverage.
#6. Dry-Mouth Meds:
A parched mouth can be a real challenge to anyone. You would usually need such treatments like artificial saliva and oral rinses to combat it. Many dental insurance plans cover these treatments, especially when it is part of a preventive care package.
#7. TMJ (Temporomandibular Joints) Disorder Medications:
Are you unable to unclench your jaw due to a TMJ disorder? Don’t worry, dental insurance has you covered for various treatments, like muscle relaxants, and pain relievers. You should know that these types of treatments have better coverage under PPO plans.
To get the best out of your dental insurance, you should try to understand the details of your coverage plan. Preventive care generally offers the best coverage for oral medications. You should also consider using an in-network provider, this would help you maximize your insurance.
See this: Does Dental Insurance Cover Cosmetic Dentistry?
How Plan Type Affects Dental Insurance Coverage For Medications
The type of dental insurance plan you use determines to a large extent the kind of coverage you get for your medications. PPOs and HMOs are the two main plan types.
We will briefly discuss them, in addition to other types of plans you could consider:
- HMO
- PPO
- Dental POS Plans
- Dental Discount Plans
1. PPO (Preferred Provider Organization):
With PPO plans, you get to choose the dentist you want to attend to you(in-network or out-of-network). This flexibility still allows you to retain some coverage but you will have to make some trade-offs.
While PPO plans offer the widest range of oral health medications, your coverage level will depend on whether you’re using an in-network or out-of-network provider/pharmacy. Choose wisely!
2. HMO (Health Maintenance Organization):
With an HMO, you choose only one dentist, but you get a lot of perks in return. HMOs usually work with in-network providers, this makes it easier to provide you with better medication coverage at reasonable cost for them.
With HMOs, you get better coverage for medications, including medications for chronic conditions. You even get a lower co-pay in comparison to a PPO plan!
3. Dental POS (Point-of-Service) Plans:
This plan is a combination of both PPO and HMO. You get a network of dentists to choose from, but there are more restrictions compared to a typical PPO plan.
If you decide to go with a Dental POS plan, you have to be ready to pay for more out-of-pocket charges.
4. Dental Discount Plans:
These are plans tailored to sort of dental bills. They are not typical insurance companies so your coverage may be slim. Medication coverage under this may even be non-existent.
You should be able to decide on a plan when you have gone through your insurance plan document. Ensure that you have understood the fine print of each plan before you opt for any of them.
You may love this: 18+ Best Health and Dental Insurance Canada
Other Factors That Affect Dental Insurance Coverage For Medication
By now, you should know what kind of medication dental insurance covers and the type of dental insurance plans that could cover your medications. But that’s not all you need.
Issues like in-network vs out-of-network providers, deductibles,co-pays, and pre-authorization, can become a roadblock to easily obtaining those medications.
Let’s quickly take a look at them:
- In-Network vs Out-of-Network Providers
- Deductibles and Copays
- Pre-Authorization
1. In-Network vs Out-of-Network Providers:
The network provider you choose will determine how much medication coverage you get.
With in-network providers, you get lower copays and deductibles because the providers in this network have stipulated rates that they charge insurance companies. These rates are usually lower than usual.
You can also get discounts for medications from pharmacies included in the network. In a case where you need prey authorization to get your medications, using an in-network provider makes the approval process smooth.
Out-of-network providers generally offer more choices, although these come at a cost. If you plan to use an out-of-network provider, you should be ready to pay more for co-pays and deductibles to get medication coverage.
Also, pharmacies do not offer the same discount benefits to patients of out-of-network providers, as they offer to in-network provider patients. You could also have some issues obtaining pre-authorization to get your prescribed medications.
2. Deductibles and Copays:
These are not your best buddies, but you have to deal with them to get coverage from your dental insurance company.
A deductible is a certain amount you pay out-of-pocket before your dental coverage kicks in. This means that if the cost of your expenses is $150, and your deductible is $100, you will have to pay the initial $100 and the tour insurance company will complete the $50. Deductibles apply to all dental insurance coverage including medication.
After the hurdle of a deductible comes the co-pay. A co-pay is the small amount you are expected to add to each covered medication. Your co-pay could be $10. So you will be expected to pay $10 for every medication you obtain.
The cost of deductibles and copays vary from plan to plan. You should consider it carefully as you choose a plan to cover your oral medication expenses.
3. Pre-Authorization:
Some medications require that your dental insurance company review the prescription before providing coverage for the cost. This may not seem important to you, but it could stand as a barrier between something as simple as your pain meds.
Your dental insurance company reviews each medical prescription based on medical necessity, cost-effectiveness, and plan coverage. You can only receive your medications following approval.
Read Also: 6+ Best Health and Dental Insurance Alberta
5 Proven Tips To Maximize Dental Insurance Coverage For Medication
Here is a guide on how to get the best out of it:
- Plan Right
- Consider In-Network Providers:
- #3. Contact Your Insurance Provider:
- Go Online:
- Pre-Authorization is Good:
#1. Plan Right:
What is the use of all the information you have gained so far if you don’t put it to work? Don’t just give each section a cursory glance, understand every detail. Ask questions until you’re clear on the type of plan, medication type coverage, deductibles, co-pays, providers, annual maximums, etc.
Look for plans that offer wide coverage for preventive medications, pain relief, and even medication for chronic conditions.
#2. Consider In-Network Providers:
You already know that in-network pharmacies provide you with better discounts, and lower copays and deductibles. This is an easy way for you to save on medication expenses. So why not consider it?
#3. Contact Your Insurance Provider:
Your insurance provider is an ally in choosing the best plan for your medications. Don’t even consider doing this without their help. Ask questions, and seek clarifications before you opt for any plan.
#4. Go Online:
On your journey to get the best medication coverage, The Insure Guide is your best friend, second only to your insurance provider.
A high percentage of the information you need on how to obtain the best medication coverage can be obtained from the Internet. You can also check out your insurance company’s website and view the information they have about their plans.
#5. Pre-Authorization is Good:
This is contrary to popular belief, but it is the truth. Obtaining pre-authorization from your insurance company ensures that you get the best medications from your providers.
Complete your paperwork with the help of your dentist and receive the medication coverage that your condition requires.
Check out this: Does Dental Insurance Cover Second Opinions?
Frequently Asked Questions
Excitingly, Yes! Dental insurance covers medications. The percentage of coverage could differ based on medication type, plan type, deductibles and co-pays, pre-authorization, etc.
Generally, there is no coverage for over-the-counter medications, nevertheless, exceptions could be made when certain medications are prescriptions from the dentist.
This is possible, but it depends on the type of dental insurance plan you are on. Some plans provide coverage for certain types of medications like antibiotics, TMJ medications, etc. Some also provide coverage for a wider range of medications.
The main difference between dental and health insurance coverage for medications is that dental insurance only provides coverage for prescriptions that come from the dentist, while health insurance provides coverage for other aspects of one's health.
Some dental insurance plans have restrictions on the type of medication that is covered. This can also affect the percentage of coverage made available for certain medications. For example; there could be limits on the number of prescriptions that can be filled per time. Does dental insurance cover medications?
Does dental insurance cover over-the-counter medications?
Does dental insurance cover prescription medications?
What is the difference between dental insurance coverage for medications and health insurance coverage for medications?
Are there any restrictions on which medications are covered by dental insurance?
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Conclusion
In the sea of options available to one, it is always best to know where you stand with dental insurance, especially concerning your medications. Ensure you use the rich information offered to you in this article, to make an informed decision on what to do about your oral medication.
Hope to see you again!