When Do Dental Insurance Plans Cover Cosmetic Dental Work?

Most people will tell you that dental insurance plans do not cover cosmetic dentistry. And they are part right.

The other side of the story is that your dentist or dental specialist (prosthodontist, periodontist, etc.) may know the ropes to get your insurer to pay for your treatment! How?

Below are a few examples when this can happen. But, first...

Why Doesn't Dental Insurance Normally Cover Cosmetic Dentistry?

The quick answer is because it is elective.

It's optional, it is not medically needed.

Dental insurance plans exist to help you cover costs related to improving or maintaining your dental health, not to make you look more attractive.

Here's a riddle: How do you define "cosmetic dental work"?

There isn't a standard definition for cosmetic dentistry. It isn't even a recognized dental specialty like orthodontics.

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What can often happen is a treatment needed to improve your oral health may also make your smile more attractive.

In these cases the cosmetic treatments could be covered by insurance, in part or in full.

When Would Insurance Pay for
"Cosmetic Dentistry"?

  • If the procedure is needed for health reasons;
  • When it's part of a comprehensive medical treatment; or,
  • It is necessary to replace existing, but faulty dental work.

Bondings - How It Could be Covered…

The easier it is to justify "medically necessary" the easier it will be to get an insurer to pay.

Here's an example, if you have a gap between your teeth, a dentist could use a composite resin material (bonding) to fill it and make it match your natural teeth.

But insurers don't consider teeth gaps medical emergencies and probably won't cover the cost.

On the other hand, if you have a chipped or a broken tooth, (or an old bonding that becomes defective) the dentist could use the material to fix the issue and the insurance company may cover some or all of the fee.

A new smile paid for by insurance.

Veneers - When Would Insurance Pay for Them?

Veneers are almost always used for "optional" (from the insurance company's point of view) cosmetic reasons. They're popular because they make teeth look straighter, whiter, and/or prettier.

Here's the thing: if you suffered damage to existing veneers, or if they're defective, your dentist could make a case to the insurer and get them to pay for their replacement.

In other words, you'd end up with new veneers and the insurance company would help pay for them.

Retired cosmetic dentist Dr. Hall gives this tip when looking for insurance money to replace old veneers: Ask the dentist to send a pre-treatment plan to the insurer for "porcelain crowns"; wait for approval; then send a revised treatment plan stating you choose "porcelain veneers" instead.

You're more likely to get approval for the veneers this way, but at the porcelain crown rate. That's to say, you'll get some money instead of no money.

The reason is because an insurance company will almost always approve porcelain "crowns" since it is the standard process (but not as aesthetically pleasing). But they'll reject all claims for "veneers" since they're seen as purely cosmetic.

Taking this approach, the insurance company would pay the rate for the crowns, even if you changed your treatment to veneers. You'd get some money for your treatment rather than none.

Inlays/Onlays - Do You Want to Get Rid of Your Gray Metal Teeth and Gums?

Metal fillings are unattractive. When you sit close to someone, like a loved one or a business client, metal fillings look bad.

I've always thought they look like big cavities. And if they sit near the gums, they could stain them black.

Porcelain onlays and inlays can be made to match your natural teeth. If you simply want to switch to porcelain onlays/inlays because they look nicer, insurance probably won't pay for it.

But if your dentist can make a medical case, such as your current fillings are old and need replacing (they don't last forever), you could get some money to replace them.

Crowns Are Often Covered by a Dental Insurance Plan

Many dental insurance plans have benefits for crowns. However, like the examples above, if you try to get them just for looks, the insurer could deny your claim and not give you any money for it.

But if your tooth is falling apart or damaged, and your dentist determines that a crown is the recommended treatment, then you can probably get some money for it.

Minor Cosmetic Work Could Be Paid For During a Routine Office Visit...

For example, if you have a very minor issue that's easily be taken care of with trimming (i.e. cracks, chips, or slightly overlapping teeth), your dentist could probably treat it at the same time you're in the office for other work. Killing two birds with one stone.

Teeth Whitening, Laser Whitening, Teeth Bleaching...

Sorry, this won't get covered. I haven't heard of any time where a dentist successfully argued that whitening or bleaching was a health or medical need.

The good news is that there is so much competition and advance methods for whitening and bleaching that costs have come down over the years and it's affordable for many people who want it.

How to Improve Your Chances of Getting Insurance to Pay for Cosmetic Dentistry

  • The tips above are meant to give you options and knowledge. Each insurance plan is different. What you should do is contact your dentist and insurance company and get the facts based on your unique situation... AHEAD of time.

  • Ask your dentist to help you through this. Chances are she has a staff member experienced dealing with insurance companies and can help you get the most money for your treatment.

  • Choose to work with a top ranked insurance plan from a well known company to get the best chance of getting insurance money to cover your treatment. In general, if you pay more (higher premiums) for your insurance plan, the more money it should have available to cover more types of procedures.

  • Beware of waiting periods. You may have to wait a while, and pay into the plan, before the insurance company pays for your treatment. That is to say, it's not good business for an insurer to take $20 for one month's premium, but then pay out $1,000 for a dental treatment. That's not a good deal for them, but it also means you might have to wait.

  • If you have influence at work, try to convince your employer to purchase a generous dental insurance plan that covers cosmetic treatments. Also, getting your dental coverage through your job, or a business you own, could save you on taxes because it's normally bought pre-tax. This brings down your total out of pocket costs.

The Easiest Place to Compare and
Buy Dental Inurance

Searching for and evaluating your dental insurance options can be confusing and take up a lot of time.

However, a number of online resources exist to help make this simple and quick.

The best known option is eHealthInsurance.com. A lot of people don't realize you can buy dental insurance from them, too.

We've used this site to get quotes, compare policies, and buy dental insurnace, health insurance, vision, hearing, and chiropractic, and life insurance.

They sell other forms of insurance as well, and make the whole process quick, simple, and painless. You could even buy pet insurance through them!

If you're looking for dental insurance for yourself or your business (and of course health, life, and other insurance). Go through eHealthInsurance.com first.




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