Posted by A recent study by the American Dental Association found that over 60% of young adults experience pain or discomfort associated with wisdom teeth. If you also experience this, you could be considering a removal but you would like to find out if “dental insurance covers wisdom teeth removal?”.
Thankfully, it does, but this depends on several factors like plan type, insurance policies, and complexity of extraction. In this article, we’ve covered all these and lots more!
Are you excited?
To get started, let’s discuss wisdom teeth removal a little.
Table of Contents
Brief Overview of Wisdom Teeth Removal and Their Importance in Dental Care
Wisdom teeth, also known as the third molars, are the last set of teeth to grow in your mouth, typically appearing between the ages of 17 and 25.
Ideally, they grow properly and smoothly aligning themselves with other already existing teeth without conjoining with them or causing the mouth much inconvenience.
Other times, the wisdom teeth choose the path of chaos by arriving without finding a good space for themselves thereby positioning at very problematic and uncomfortable corners in your mouth causing you so much pain and discomfort.
They might emerge sideways, pushing against other teeth, leading to overcrowding, pain, and potential infections. Sometimes, they might remain stubbornly trapped beneath your gums, causing inflammation and future complications.
When this becomes the case, the best your dentist can do is recommend a removal.
Do you think Dental Insurance Covers Gum Grafts? Read this to gain clarity!
Does Dental Insurance Cover Wisdom Teeth Removal?
Most dental insurance plans cover wisdom teeth removal but coverage is usually not direct because this coverage depends on several factors like your dental insurance plan, the complexity of the extraction, and your specific policy.
Let’s expand on them briefly:
1. Your Dental Insurance Plan:
- PPO: More flexibility in choosing dentists, but higher out-of-pocket costs for out-of-network providers. Wisdom teeth removal is usually covered under major procedures.
- HMO: Lower premiums, but limited to in-network dentists. Wisdom teeth removal is often covered if medically necessary (pain, infection, impaction).
- DPPO: Hybrid of PPO and HMO, offering more freedom than HMOs but less than PPOs. Wisdom teeth coverage was similar to PPOs, under major procedures.
- Indemnity Plans: Reimbursement based on a pre-determined schedule, regardless of dentist. Coverage varies depending on the plan and fee schedule.
2. Complexity of the Removal:
Simple extractions of non-impacted teeth are typically covered by most plans. More complex procedures, like removing impacted teeth, may have higher co-pays or not be covered at all.
3. Your Specific Policy:
Always revisit your policy booklet. You need to understand that every plan is different, so check what’s covered and under what conditions. Contact your insurance company from time to time. They can clarify specific procedures and coverage details.
Read Also: Does Dental Insurance Cover Sealants?
Which Dental Insurance Plans Cover Wisdom Teeth Removal?
As we said earlier, most dental insurance plans do cover wisdom teeth removal, but the specifics like which of your procedures are covered and how much of your out-of-pocket cost will depend on several factors, especially the type of dental insurance plan you have including:
-
PPO (Preferred Provider Organization):
These plans are so flexible in allowing you to choose a dentist, but you may pay more out-of-pocket if you see an out-of-network provider. Wisdom teeth removal is typically covered under major dental procedures in PPO plans.
-
HMO (Health Maintenance Organization):
HMO plans have lower premiums but require you to see dentists within their network. Wisdom teeth removal is usually covered if deemed medically necessary, such as in tooth pain, infection, or impaction cases.
-
DPPO (Dental Preferred Provider Organization):
DPPO plans are a hybrid of PPO and HMO plans, offering you more freedom than HMOs but less than PPOs. Wisdom teeth coverage is usually similar to PPO plans, falling under its major procedures.
-
Indemnity Plans:
These plans reimburse you for a portion of your dental expenses based on a predetermined fee schedule. Coverage for your wisdom teeth extraction varies depending on your specific plan and fee schedule.
Let me ask you… Do you think Dental Insurance covers Orthodontics? Not sure? Then check out this amazing guide.
Tips For Maximizing Your Dental Insurance Coverage For Wisdom Teeth Removal
Here are some general tips for maximizing your dental insurance coverage for wisdom teeth removal:
1. Schedule a consultation with your dentist:
Your dentist can help you determine the best course of treatment for your wisdom teeth and can also give you an estimate of how much your insurance will cover.
2. Choose an in-network provider:
If you have a PPO or DPPO plan, you will easily save money by choosing an in-network dentist or oral surgeon.
3. Ask about preauthorization:
Some insurance companies require preauthorization for certain procedures, such as wisdom teeth removal. You have to check with your insurance company before having the procedure done.
4. Consider an FSA or HSA:
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) allow you to set aside pre-tax dollars to cover medical expenses, including dental care. These accounts can help you save money on your out-of-pocket costs for wisdom teeth removal.
How Much Does Wisdom Teeth Removal Cost With Dental Insurance?
The average cost per wisdom tooth with dental insurance is $200 to $1,100. And, the average cost for removing all four wisdom teeth with dental insurance is $2,564.
To know the exact cost of your wisdom teeth removal, you have to consider the following factors:
- Your insurance plan
- Complexity of the removal
- Location and provider rates
- Your out-of-pocket expenses
#1. Your Insurance Plan:
Coverage for wisdom teeth varies across plans. Check your policy or contact your provider for specifics.
#2. Complexity of the Removal:
Let’s break this down for you:
Simple extractions of non-impacted teeth are generally cheaper.
Impacted teeth, require specialized surgical techniques, which will typically cost you more.
Additional costs may arise for anesthesia, X-rays, or post-operative care.
-
Location and Provider Rates:
Your location and the dentist/surgeon’s rates can impact your cost. Urban areas often have higher costs compared to rural areas.
-
Your Out-of-Pocket Expenses:
Even with dental insurance, you might still face co-pays, deductibles, and potentially uncovered procedures. So you have to review your policy to understand your specific cost-sharing responsibilities.
Read Also: Does Dental Insurance Cover Cosmetic Dentistry?
How Much Is Wisdom Teeth Removal Without Dental Insurance?
Below are rough estimates of what you could expect to pay without insurance:
- Simple extraction of one non-impacted tooth: $400 to $800
- Removal of all four wisdom teeth with simple extractions: $1,600 to $3,200
- Removal of one impacted tooth with general anesthesia: $1,500 to $3,500
- Removal of all four impacted teeth with general anesthesia: $6,000 to $14,000
Cost of Wisdom Teeth Removal Without Insurance
Without dental insurance, you will spend so much on wisdom teeth removal, with costs varying widely depending on these factors:
1. Complexity of the Removal:
Simple extractions of non-impacted teeth: The most affordable option, ranging from $200 to $400 per tooth on average.
Impacted or surgically removed teeth: Significantly costlier due to increased complexity and additional techniques. Prices can climb to $250 to $1,100 per tooth, and even higher for severely impacted teeth requiring extensive surgery.
2. Location And Provider Rates:
Urban areas generally have higher costs compared to rural areas. The reputation and specialization of the dentist or oral surgeon can also affect cost.
3. Type of Anesthesia:
Local anesthesia: Lower cost option, generally included in the extraction fee.
General anesthesia: Required for more complex procedures or patients with anxiety. Significantly increases the cost, adding $500 to $1,000 or more.
4. Additional costs:
X-rays or CT scans: Necessary for diagnosis and treatment planning, adding $50 to $200 per scan.
Post-operative medications and visits: Sometimes can add another $50 to $100.
Strategies To Help You Maximize Your Dental Insurance For Wisdom Teeth Extraction
Here are strategies that you can apply to maximize your wisdom teeth removal coverage:
- Decoding your plan
- Reason and result matter
- Network advantage
- Preventive power
- Open communication
#1. Decoding Your Plan:
You must understand what your insurance plan is all about. You must pay attention to keywords like “Oral surgery”,” wisdom teeth”, and “coverage percentages” If you find any unclear provisions during your research, do not hesitate to contact your insurance provider.
#2. Reason and Result Matter:
As we earlier stated, the reason why you seek to remove the teeth largely affects your coverage. If your reason falls under the medically necessary procedures that are due to pain or infection then generally you’d get better coverage than when you want to take preventive measures to avoid future problems.
Make yourself clear to your dentist and insurance provider which case it is.
#3. Network Advantage:
In-network providers are your surest advantage and you should stick with them to reduce out-of-pocket costs. Research providers within your plan’s network and schedule consultations to understand which one perfectly suits your needs and pocket.
-
Preventive Power:
Regularly checking your teeth can help you identify potential wisdom teeth issues giving you the advantage of more affordable treatment options before the case requires more serious attention.
-
Open Communication:
Keeping open communication between you and your dentist throughout the process will keep you guided as they act as your translator, advocating for the most appropriate treatment while maximizing your insurance coverage.
Some Expert Proactive Dental Care Tips To Reduce Your Need For Wisdom Teeth Removal Procedure
Here are some tips to minimize your risk of needing wisdom teeth removal:
- Regular dental checkups and cleanings.
- Good oral hygiene
- Early intervention
- Dietary choices
- Listen to your body
-
Regular Dental Checkups and Cleanings:
Regular visits to your dentist allow him or her to monitor your wisdom teeth development and identify potential issues early on.
-
Good Oral Hygiene:
Brushing and flossing regularly can help keep your mouth healthy and reduce the risk of gum disease, which can worsen wisdom teeth problems.
-
Early Intervention:
If your dentist identifies wisdom teeth that are likely to cause problems, they might recommend pre-emptive removal while the roots are still developing, potentially making the procedure easier and less costly.
-
Dietary Choices:
When you notice that growth at the back of your mouth, opt for softer foods. Chewing on tough or crunchy things when your wisdom teeth are on the move, can escalate your pain and discomfort.
-
Listen To Your Body:
Pay attention when you observe any pain, swelling, or difficulty chewing. These could be signs of trouble brewing, and an early visit to your dentist can help determine the best course of action.
Frequently Asked Questions
[sc_fs_multi_faq headline-0=”h3″ question-0=”My wisdom teeth are impacted, does that affect coverage?” answer-0=”Yes of course impacted teeth trapped in the gum or bone will require complex procedures for removal hence the coverage might be limited compared to simpler procedures for teeth that have fully erupted and demand little intricacies.” image-0=”” headline-1=”h3″ question-1=”What if my wisdom teeth aren’t causing any problems?” answer-1=”This is where things get trickier. Even if your wisdom teeth aren’t currently causing pain or issues, some preventative extractions might be covered if your dentist deems them necessary to avoid future problems. However, if your reason for removal is purely cosmetic then you’ll not be covered.” image-1=”” headline-2=”h3″ question-2=”I have two different insurance plans, which one covers the removal?” answer-2=”We’d advise you to contact both insurance providers. Find out the percentage coverage of the offer and their plan specifics then choose based on the most friendly to your budget and needs.” image-2=”” headline-3=”h3″ question-3=”I don’t have dental insurance, what are my options?” answer-3=”Don’t fret! Talk to your dentist about payment plans or financial assistance programs they might offer. You can also consider using a flexible spending account (FSA) or health savings account (HSA) to help cover the costs.” image-3=”” count=”4″ html=”true” css_class=””]
Important Recommendations
- Does Dental Insurance Cover Root Canals
- Does Dental Insurance Cover Cavities
- 10 Best Dental Implant Insurance in the UK
Conclusion
We hope this information helps you find your way around getting rid of that unwanted growth. We also want to let you know that removing your wisdom teeth is your personal decision which is best made in consultation with your trusted dentist.
By understanding your insurance coverage, weighing the pros and cons, and practicing proactive dental care, we know you can navigate the wisdom teeth maze with confidence and hopefully wear a pain-free smile.
Check out more of our works.
We appreciate your presence!