Does Dental Insurance Cover Periodontal Disease? #1

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Whether you have periodontal disease or you are among those asking “Does dental insurance cover periodontal disease?”, You just got your solution. Luckily for you, the information you need to be armed is already in this article.

At the end of this article, you will get all the answers to your questions on dental coverage for periodontal diseases.

Have fun educating yourself!

What is a Periodontal Disease?

Periodontal Disease, also called gum disease is an infection of the tissues around one’s teeth. If left untreated, it can lead to bone loss, inflammation, and eventual tooth loss for the affected person.

As a matter of fact, Periodontal disease happens to be the leading cause of tooth loss in adults. Shocking statistics from the American Dental Association show that 50% of adults over 30 suffer from gum disease! 

Now to what really brought you here

Does Dental Insurance Cover Periodontal Disease?

Yes, most dental insurance plans offer some level of coverage for periodontal disease, though the extent of coverage can vary depending on the specifics of your dental insurance plan, severity of the periodontal disease, type of treatment, and others.

Let’s briefly look into them one after the other.

Factors That Determine Your Dental Insurance Coverage For Periodontal Diseases

Below are the factors that determine whether your dental insurance will cover periodontal diseases:

  • The Specifics of Your Dental Insurance Plan:
  • Severity of the periodontal disease
  • Type of treatment
  • Age
  • Pre-Existing Conditions

#1. The Specifics of Your Dental Insurance Plan:

The plan type can be a major factor. Generally, PPO plans offer you the most comprehensive coverage for periodontal disease, followed by POS plans and then HMO plans.

Annual maximum and coverage percentage also determine whether you will be covered. These limits usually determine the total amount your dental plan will pay out for your periodontal treatments each year and the percentage they’ll cover of the approved amount.

Some dental plans do have waiting periods before certain periodontal treatments are covered. You have to the specifics of your plan.

#2. The severity of the Periodontal Disease:

Many dental plans cover preventive measures like cleanings and scaling for gingivitis and early-stage gum disease. Some dental plans limit their coverage for more advanced treatments like scaling and root planing, laser therapy, and gum surgery may subject it to higher out-of-pocket costs.

You May Love To Know Whether Dental Insurance Covers Periodontal Diseases

#3. Type of Treatment:

Non-surgical procedures are usually considered invasive treatments and their coverage for periodontal disease is usually hard.

Surgical and extensive procedures like bone grafting or flap surgery usually have higher co-pays or coinsurance requirements.

#4. Age:

There are certain dental plans specifically designed for seniors above (age 65) that may offer enhanced coverage for periodontal disease. So if you’re or have some in that age bracket, you have a chance for coverage.

#5. Pre-Existing Conditions:

Some plans may exclude coverage for periodontal disease if you have a pre-existing dental issue at the time you enrolled in the plan.

Does Dental Insurance Cover Periodontal Disease?
Most dental insurance plans offer some level of coverage for periodontal disease, though the extent of coverage depends on some factors.

Read Also: Does Dental Insurance Cover Anesthesia?

How Does Dental Insurance Cover Basic Periodontal Procedures?

Periodontal disease manifests in different stages. Each stage has its specific insurance coverage. As we run down the list, look out for the group you fall into and read up about the dental insurance plan available to cover it.

1. Preventive Care:

These are usually 100% covered by your dental insurance plan. This is because they don’t cost much and they help your gums stay healthy. Preventive care helps you avoid major treatments like periodontal disease procedures.

They comprise of:

  • Cleanings: To get rid of plaques and tartar. This happens bi-annually and is 100% covered.
  • Exams: This will help your dentist discover whatever disease you might have early. Diseases like gingivitis (mild gum inflammation) can be detected early before it gets worse.

2. Diagnostic Services:

Early detection equals a reduction of cost, so your insurance company could easily jump on this and cover about 80% of the cost because it will save them money in the long run.

X-rays, gum assessments, and other tools for diagnosing periodontal disease are all part of the package.

Check this out: Does Dental Insurance Cover Gum Grafts?

How Does Dental Insurance Cover Major Periodontal Procedures?

The amount of coverage given by dental insurance companies for major procedures varies depending on the procedure. Your plan may cover about 50% of the total cost for periodontal diseases.

  • Medications:

The coverage for antibiotics can vary depending on the type of plan. Consult your insurance provider to be certain.

  •  Gum Flap Surgery:

This is a step above the medications. It involves opening up the gum for deep cleaning before the actual treatment. Coverage for this is usually 50-60%.

  • Bone Grafting:

This is when bone loss has occurred, and there is a need to support tooth structure. The procedure costs more than the others. Insurance coverage for this is usually 30-50%. In special cases, your insurance plan may not cover it at all.

Don’t forget to always consult your dentist and have them walk you through specific plans and their coverage details. This will best prepare you in the case of a periodontal disease.

Read Also: Does Dental Insurance Cover Sealant?

Cost Considerations That Can Affect Your Periodontal Treatment Options

You might think you have it covered. Not really! There are little clauses in your dental insurance plan that can affect your treatment options and out-of-pocket costs.

They include:

  • Deductibles
  • Annual Maximum
  • Exclusion
  • Pre-existing Conditions

Take a look!

#1. Deductibles:

This is the part your insurance company expects you to pay for your treatment before they actually start covering for you. For example; If your deductible is $200 and your periodontal treatment costs $500, you’ll pay the first $200 out-of-pocket.

#2. Annual Maximum:

There is a maximum amount that your insurance plan covers annually. If you have maxed out your limit, coverage for a periodontal disease treatment will be limited.

#3. Exclusion:

Some insurance plans cover some periodontal disease treatments and exclude others. Reasons include; cosmetic procedures, experimental treatments, and pre-existing conditions.

#4. Pre-existing Conditions:

If you found out about your periodontal disease before you decided to pick up a plan, then you need to know this. To have insurance coverage for periodontal disease, you might have to wait for a long time and your coverage may also be limited.

The best way to tackle this is to consult your dentist before taking any action toward acquiring an insurance plan for your periodontal disease treatment. This will help you make good decisions about what works for you.

Ways To Beat Periodontal Diseases With The Right Planning

Wouldn’t it be splendid if you didn’t have to worry about periodontal diseases at all? Here are a few ways to make that happen:

  • Prevention
  • Don’t Wait Till Trouble Comes
  • Early Detection Is The Next Best Thing

1. Prevention:

Prevention is everything. With it, you won’t have to worry about whether or not your insurance plan would cover your periodontal disease treatment because there wouldn’t be a need for treatment in the first place.

The best thing about preventive care is that they are usually 100% covered by insurance plans. Little additions like X-rays and deep cleaning usually don’t cost that much. Invest in preventive care coverage and keep that smile for a long time.

2. Don’t Wait Till Trouble Comes:

Don’t you just love it when a little emergency comes up and you have some money tucked away? It’s the same for periodontal disease treatment. You don’t have to wait till it happens.

You should discuss the potential risk of a periodontal disease with your dentist. Factors like genetics, smoking, and existing gum problems can affect the type of plan you choose.

Double down on the fine print of different insurance plans and consult your dentist to see how each fits you. Your dentist can help you by:

  • Recommending plan types and coverage that would be best suited for you. To do this, they will consider your needs and risk factors.
  • Clarifying potential exclusion and limitations for you. This would help you understand what your plan covers and avoid potential surprises as you go along.

3. Early Detection Is The Next Best Thing:

If you’re not able to prevent a periodontal disease altogether, then early detection is the next best thing that can happen to you. Make regular checkups a habit so any gum disease can be caught early.

Regular checkups are also important for:

  • Monitoring Your Periodontal Health: If your disease is discovered early, your dentist can adequately monitor your treatment and make adjustments when it is required.
  • Keeping Your Smile: Regular checkups see to it that your overall oral health is covered consistently. This saves you time, money, and stress in the long run. Remember your smile is a priority and you should plan to always keep it in place.

Alternatives To Periodontal Treatments

You may not have the money to go the traditional route of insurance for periodontal care. No worries! There are plenty of options available. Read through and find one that is tailor-made for your pocket.

Here are some alternatives to periodontal treatments:

  • Discount Dental Plans
  • Dental Schools and Clinics
  • Payment Plans and Financing
  • Public Assistance Programs
  • Preventive Measures and Home Care

Let’s discuss them one after the other.

#1. Discount Dental Plans:

These are dental programs that offer lower rates on the dental services they offer. They don’t operate like a typical insurance plan, so they may not directly cover costs, but they significantly bring down the prices on cleanings, exams, and even periodontal treatments.

#2. Dental Schools and Clinics:

Several universities and clinics offer dental services at a reduced rate for individuals. Practicing dentists and supervised students work here to give affordable care. Their options, especially for cleanings and scaling, are usually budget-friendly.

#3. Payment Plans and Financing:

Many dentists allow clients to use a flexible payment plan option. They break down treatment costs into monthly installments that are manageable for individuals. With a flexible plan like this, expensive procedures like gum surgeries are even possible.

#4. Public Assistance Programs:

Programs like Medicare or Medicaid are available coverage plans established by the government for families and individuals. These programs offer partial and sometimes full coverage for basic dental care and even major procedures like periodontal disease treatments. They are only available for eligible families. Make inquiries to find out if you qualify.

#5. Preventive Measures and Home Care:

You can minimize the cost of dental care for yourself. Brushing, flossing and fluoride use should become an important part of your daily routine. This will help avoid potential periodontal diseases and save you a lot of money in the future.

Frequently Asked Questions

[sc_fs_multi_faq headline-0=”h3″ question-0=”What is the connection between periodontal diseases and other health conditions?” answer-0=”Periodontal diseases have been linked to some health conditions like; heart diseases, diabetes, and respiratory diseases. Although there are still ongoing studies to fully verify these claims.” image-0=”” headline-1=”h3″ question-1=”How can you prevent periodontal diseases?” answer-1=”You can avoid periodontal diseases by preventive care. Make flossing, brushing, and regular checkups, part of your routine It’s also important to avoid smoking and eat a healthy diet.” image-1=”” headline-2=”h3″ question-2=”What are the risks of not treating periodontal diseases?” answer-2=”If periodontal disease is not treated, it can lead to serious health complications including tooth loss. It is important to seek treatment for periodontal disease immediately and avoid risk these risks.” image-2=”” headline-3=”h3″ question-3=”Is there a difference between private and public dental insurance coverage for periodontal disease?” answer-3=”Yes, there is a difference between private and public dental insurance coverage for periodontal disease. Private dental insurance plans typically offer more comprehensive coverage than public plans, and they may also cover more of the costs associated with treatment. However, it’s important to review your specific plan to understand what is and is not covered.” image-3=”” headline-4=”h3″ question-4=”Can I use my health savings account to pay for periodontal treatments?” answer-4=”In some cases, you may be able to use your health savings account (HSA) to pay for periodontal disease treatment. HSAs are a type of savings account that can be used to pay for certain medical expenses, including dental care. However, the specific rules and regulations around using this account to pay for your treatment.” image-4=”” count=”5″ html=”true” css_class=””]

Important Recommendation


Taking control of your dental health is key to keeping that smile on. There’s no better time to start than now. Remember your dentist is your friend and will always keep your best interest at heart.

Always ask questions about whatever insurance plan you’re interested in. If all else fails, consider alternatives!

Feel free to check out other articles of ours.

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