Dental Insurance Coverage for Crowns – Dental insurance is an essential part of oral health maintenance, as it helps you handle dental care costs. Expensive procedures like dental crowns are one of the medical expenses that dental insurance helps policyholders cover. For those who are not aware, dental crowns are caps that are usually placed over a tooth to restore its appearance, shape, strength, and size.
This makes a lot of people with dental insurance ask this question: Does dental insurance cover crowns? As mentioned earlier, this is a very expensive medical procedure, and covering it out-of-pocket can be hard, especially if you are not financially buoyant. In this article, you will be exploring the extent to which dental insurance covers crowns and the events and situations where coverage may be denied.
Does Dental Insurance Cover Crowns?
The answer to the question, Does dental insurance cover crowns? is s yes. The majority of dental insurance plans include coverage for crowns. However, the extent or level of coverage as well as the conditions depend significantly on the specifics of the insurance policy. Meanwhile, crowns are under major procedure; therefore, full coverage will not always be available. However, dental insurance typically covers 50% to 80% of the crown cost, depending on the policy details.
Dental Insurance Coverage for Crowns
Dental insurance typically offers crown coverage because it is seen as medically necessary, unlike a purely cosmetic procedure. Here are some medically necessary reasons why dental insurance covers crowns:
- Keeping a dental bridge in place.
- Protecting a weak tooth.
- Holding a cracked tooth together.
- Improving a tooth’s appearance.
- Restoring a broken tooth.
- Covering a dental implant.
- Covering and supporting a tooth with a large filling when there are no teeth left to hold it.
When is Coverage not Received?
You may be able to get coverage for crowns with your dental insurance if any of the following happens:
- Cosmetic reasons: If a crown is placed for aesthetic improvements without a functional necessity, insurance will not provide coverage.
- Frequency limitations: Most insurance plans come with frequency limitations on how often they cover a crown on the same tooth. This is usually once every 5 to 10 years.
- Pre-existing conditions: Some insurance policies do not cover conditions that were already existing or present before the person applied for an insurance policy.
What Does Typically Dental Insurance Cover?
Dental insurance usually covers a range of services that are categorized as basic, preventive, and major procedures. They include the following:
- Routine cleanings.
- Exams.
- X-rays.
- Fluoride treatments (in some cases).
- Fillings.
- Tooth extractions.
- Root canals (in some cases).
- Crowns.
- Bridges.
- Dentures.
- Orthodontics (in some cases).
How Much Does a Dental Crown Cost With Insurance?
The price of getting a dental crown can differ depending on the insurance company, the geographic location, the material used, which is either metal, composite, or porcelain resin, and the fees of the dentist. On average, the cost of getting a crown is around $800 to $1,700, probably more per tooth if a person does not have insurance.
On the other hand, people with insurance may need to pay less depending on their insurance policy’s coverage limits, copayments, and deductibles. For example. If the crown’s total cost is $1200 and coverage is at 50%, the policyholder will be responsible for the $600 as well as any deductible.
What Happens If I Can’t Afford a Crown?
If you are unable to afford a dental crown, it is not the end of the world since there are other alternatives to check out. For instance, you can make use of dental discount plans and discover financing options or payment plans with your dentist. Apart from this, you can check out community health clinics or go to dental school for affordable costs.
FAQs
Will my dental insurance cover a crown immediately after I enroll?
Many dental insurance plans come with waiting periods for specific types of coverage, and crowns are not an exception. It is important to go through your policy details for specifics.
Why are dental crowns so expensive?
Dental crowns are expensive due to the high-quality materials used, the advanced technology required for fitting, and the significant time and skill involved in the procedure.
Do dentists guarantee crowns?
Many dentists offer warranties or guarantees on crowns for a specific period, typically ranging from one to ten years, covering defects in materials or workmanship. However, the specifics can vary by dental practice, so it is important to discuss this with your dentist.
Can I choose the type of crown I want?
Yes, but your choice might affect how much is covered by insurance. For example, more expensive materials like porcelain might not be fully covered compared to less expensive materials.
What if I need a crown replaced that was done recently?
Insurance typically will not cover the replacement of a crown unless a certain period has passed, usually 5–10 years, unless there is a documented failure of the crown.