Posted by Someone is still asking, “Does dental insurance cover oral surgery?”. It may surprise you to know that although almost 70% of Americans have dental insurance, many are still unaware of the operations that are covered. Since oral operations can be costly, it’s important to know what your dental insurance covers.
Excitingly, dental insurance does cover oral surgeries but it depends on your medical insurance procedures and the type of oral surgery you are going for. This blog post has the needed facts for your oral dental insurance coverage.
Table of Contents
Does Dental Insurance Cover Oral Surgery?
Most dental insurance plans cover oral surgeries but this depends entirely on the extent of coverage on your insurance plan, the type of surgery, and even the reason for needing it. For example, a simple wisdom teeth extraction might be covered, while a more complex jaw surgery might not.
However, medical insurance may step in for certain medically necessary oral surgeries. If your oral surgery is deemed essential for your overall health.
Expect your dental coverage to typically range from 50-80% for covered procedures, but remember, individual plans vary. Annual maximums and deductibles apply, so watch out for those caps and out-of-pocket costs.
The #2 Key Procedures Populalry Under Oral Surgery Coverage:
1. Wisdom Teeth Removal:
- Simple Extraction: This is covered under most dental plans unless complications arise, like impacted teeth requiring bone removal.
- Surgical Extraction: More complex cases may require additional coverage or higher out-of-pocket costs.
2. Dental Implants:
They are typically not fully covered by dental insurance, though some plans offer partial coverage for the crown or bridge placed on the implant.
Does Dental Insurance Cover Retainers? Check this out!
4 Factors Influencing Dental Insurance Coverage for Oral Surgery
Below are the factors that play a role in determining dental insurance coverage for oral surgery:
- The Types of Oral Surgery
- Your Specific Dental Insurance Plan
- The Reason For The Surgery
- Plan Limitations:
#1. The Types of Oral Surgery
The type of surgery plays a major role in predicting the ending. Let’s delve into the coverage specifics for some common procedures:
- Wisdom Teeth Removal: A portion of the extraction will be covered for your wisdom teeth removal in most plans for simple and less complex cases. It is necessary to check exclusions for impacted teeth or oral surgery that requires general anesthesia which sometimes is covered by medical insurance.
- Jaw Surgery: You can get some coverage for this depending on the reason and complicacy of your jaw surgery. Some plans might offer limited coverage while some may cover a major portion.
Key questions: Is it for correcting a birth defect (often covered by medical insurance) or due to an accident (may involve both medical and dental coverage)? - Implants: Implants are seen as ‘cosmetic’ and for this reason, they are excluded and not covered in most cases. However, some policies might offer partial coverage if medically necessary (e.g., replacing a jawbone section).
- Gum surgeries: Basic procedures for gum grafting are covered. However, there are some exclusions for most periodontal diseases.
- Tumor removal: This depends largely on the medical necessity as your coverage falls in if it is under medical or dental insurance.
Is Oral Surgery Covered Under Medical or Dental Insurance? Gain some clarity here.
#2. Your Specific Dental Insurance Plan
Always check your specific policy document for clarity of details:
Basic Plans:
- Limited coverage: This coverage is majorly for simple tooth extractions. Wisdom teeth removal or more complex procedures are less covered.
- High deductibles and co-pays: Expect to pay a significant portion of the cost out-of-pocket.
- Annual maximums: May have caps on the total amount they will pay for oral care in a year which includes surgeries.
Mid-Tier Plans:
- Better coverage: This covers a wider range of procedures, including some wisdom teeth removal and less complex oral surgeries.
- Lower deductibles and co-pays: May offer more financial relief compared to basic plans.
- Still limitations: There may be exclusions for specific procedures or limitations on coverage amounts.
Premium Plans:
- Most comprehensive coverage covers a wide range of oral surgeries, which includes wisdom teeth removal, implants, and even some jaw surgery.
- Low deductibles and co-pays: Usually offer the most financial assistance for major procedures.
- Still exclusions: Exclusions for certain procedures and pre-existing conditions may occur.
#3. The Reason For The Surgery
The reason oral surgery gets covered by your dental insurance depends on a crucial factor. Let’s break it down into two categories which are the coverage nuances:
Medically Necessary Surgery:
Most dental insurance plans provide partial coverage for medically necessary oral surgery. This includes procedures crucial for your oral health and overall well-being, such as:
- Wisdom teeth removal: Wisdom teeth inflicting pain on other teeth usually fall under coverage.
- Jaw surgery: Corrective procedures for severe jaw misalignment or joint issues are often deemed medically necessary.
- Tumor or cyst removal: Surgeries to remove oral tumors or cysts affecting your oral health typically qualify for coverage.
- Infection treatment: Procedures to address severe infections like abscesses or cellulitis might be covered.
However, the amount covered varies based on your specific plan. Expect a coverage percentage ranging from 50% to 80% of the cost, with your portion covered by deductible, coinsurance, and copays.
Cosmetic Surgery:
Dental insurance primarily focuses on maintaining oral health, so purely cosmetic procedures are rarely covered. Examples include:
- Dental implants for purely aesthetic reasons.
- Jaw contouring for facial reshaping.
- Gum reshaping for an even gum line.
There are some exceptions in rare cases, as cosmetic surgery might be partially covered if it has a functional impact. For example, jaw surgery for sleep apnea could be considered medically necessary.
Birth Defects: Surgeries to correct congenital (present from birth) dental defects like cleft palate or jaw deformities are considered medically necessary and fall under your medical insurance coverage. However, your plan may have specific requirements or limitations for coverage.
Accidents: If the oral surgery results from an accident like a broken jaw or severe facial trauma, both your medical and dental insurance will cover the procedures related to facial bones and tissues as well as coverage for bone grafting, tooth extraction, and implant placements needed for jaw reconstruction.
#4. Plan Limitations:
- Annual Maximums: Most dental plans have annual maximums, which limit the total amount they will pay for covered services in a year. This means even if your plan covers oral surgery, you may be responsible for any costs exceeding the maximum.
- Waiting Periods: Some plans have periods for major services like oral surgery, which means you may have to wait a certain amount before the procedure is covered. Some plans impose waiting periods before covering certain procedures, especially major ones like jaw surgery.
- Pre-approvals: Many plans require pre-approval for oral surgery before they will cover any costs. This helps the insurance company determine if the surgery is medically necessary and how much they will cover. Some plans also require pre-approval for specific procedures, especially expensive ones.
- Exclusions: Some plans exclude certain types of oral surgery from coverage, such as cosmetic procedures, wisdom teeth removal if deemed non-emergent, or surgeries related to pre-existing conditions.
While most plans cover basic surgeries like wisdom teeth removal, they often exclude cosmetic procedures like implants or gum reshaping. Pre-existing conditions like gum disease might also be excluded.
Does Medical Insurance Cover Dental Surgery? You will love to see this!
Out-of-Pocket Costs Associated With Dental Insurance For Oral Surgery
Estimating out-of-pocket expenses after insurance is difficult, as it depends on a multitude of factors. However, here’s a rough breakdown, based on national averages:
Wisdom teeth removal: With dental insurance, expect to pay an average of $500-$1,500 per tooth, depending on the complexity and anesthesia used. Without insurance, costs can skyrocket to $4,000-$10,000+ per tooth.
Dental implants: With insurance, out-of-pocket costs for a single implant can range from $1,500-$3,000, while full-mouth reconstructions can top $30,000. Without insurance, expect to pay $3,000-$6,000 per implant and $50,000 and more for a full-mouth restoration.
These are just estimates as your actual costs might be significantly higher or lower. Always get a detailed cost breakdown from your dentist and contact your insurance provider for their specific coverage details.
Guides To Reducing Out-of-Pocket Expenses On Dental Insurance For Oral Surgery
Here are some guides you should follow to reduce your out-of-pocket expenses:
- Shop around: Compare costs and coverage plans from different dental insurance providers before choosing one.
- Negotiate with your dentist: Discuss payment options and see if they offer discounts for upfront payments or cash.
- Explore financing options: Some dental offices offer financing plans for larger procedures.
- Consider cost-sharing programs: Organizations like CareCredit offer medical financing options.
- Ask about in-house savings plans: Many dental offices offer discounted rates for uninsured patients.
Alternative Options If You Are Unable To Get Insurance For Oral Surgery
Below are alternatives you can consider:
- Dental savings plans: These plans offer discounts on services without the traditional insurance structure. They typically have lower monthly fees but limited coverage compared to regular insurance.
- Community health centers: Some clinics offer discounted or free dental care for low-income individuals.
- Dental schools: Often, dental schools offer reduced-cost treatment by students under faculty supervision.
4 Tips On How to Maximize Your Dental Insurance For Oral Surgery
To make the most out of your dental insurance plan, follow these tips:
- Check for fee hike
- Make sure you’ve hit your deductible
- Maximize your premiums each month
- Visit your dentist regularly
#1. Check for fee hike:
There is always a fee hike at the beginning of the year, as this is inevitable, and it impacts your dental insurance benefits. Always check your insurance policy to determine if you have any unused benefits and avoid any additional costs due to fee increases.
#2. Make sure you’ve hit your deductible:
Your deductible is what you pay out-of-pocket for dental services before your insurance company pays for your treatment. Your deductible, typically $50, will reset at the beginning of each year.
You can call your dental insurance company and find out whether you’ve hit your deductible. If not, consider scheduling a cleaning or any dental treatment that you have been delaying.
#3. Maximize your premiums each month:
A premium is the amount you pay to your dental insurance company each month. To maximize your dental insurance premiums, keep up with your regularly scheduled checkups.
After all, checkups and cleanings help prevent gum disease and cavities as well as detect any signs of oral cancer or other health issues.
#4. Visit your dentist regularly:
One of the best ways to maximize dental coverage is to make regular appointments with your dentist. Visiting your dentist at least once every six months is a smart preventative measure you can take for your health. Catching dental issues early on can help you save money in the long run.
Frequently Asked Questions
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- Does Dental Insurance Cover Oral Cancer Screening?
Conclusion
Dental insurance for oral surgeries covers 100% cost of basic services, including fillings and non-surgical extractions. However, knowledge is power. Understanding your dental plan specifics is crucial to managing oral surgery costs.
Analyze your plan types, potential pre-existing conditions considerations, deductibles, and provider network limitations. Don’t hesitate to ask your dentist or oral surgeon questions about the procedures, potential costs, and insurance coverage.
Hope to see you again!
Cheers!