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Why Doesn’t Health Insurance Include Dental Coverage?

Why Doesn’t Health Insurance Include Dental Coverage?


The truth is there’s no particularly satisfying answer. A long time ago, dentistry and minor surgery were performed by the barber. In fact, the red-and-white barber pole originally symbolized both bloodied and clean bandages. But as bloodletting fell out of fashion (thank goodness), barbers stopped performing surgery but continued to provide dental treatments.  

Basically, this caused a split between the disciplines of dentistry and medicine. Dentistry was no longer considered a part of healthcare. The distinction has continued into modern times, even though barbers have long stopped involvement with either.    

Of course, this “reason” seems a bit antiquated and even downright ridiculous. Unfortunately, health insurance providers really have no incentive to change. Today, health insurers consider many dental procedures to be elective. So they’re not covered because they’re not considered necessary for good health.   

Does Health Insurance Ever Cover Dental Care? 

In most cases, health insurance does not cover dental care. But there are a few notable exceptions. Dental care can be covered if it’s medically necessary.  

What is medically necessary dental care? Basically, it’s any dental procedure performed in a hospital. This is mainly damage to your teeth, mouth or jaw caused by an accident or injury. For instance, if you suffer damage to your face in an auto accident, any emergency dental surgery in the hospital will likely be covered.  

Health insurance will also typically cover procedures related to chronic medical conditions. These include tooth extractions and surgeries related to oral cancers. Plus, certain heart valve replacements and kidney transplants typically require dental exams, which are also often covered by health insurance.  

Most health insurance plans will only cover procedures performed in the hospital. Follow-up care is not included. So if you suffer an injury and receive dental treatment in the emergency room, health insurance won’t cover any follow-up treatments you may need later at the dentist’s office.  

What Conditions Need To Be Met For Health Coverage? 

Health coverage for dental procedures works the same as filing any other type of health insurance claim. You’ll need to pay your deductible before a claim can be filed. The specific procedure might also require a co-pay. 

Plus, waiting periods, pre-existing conditions and maximum payout limits might also be factors. Dental insurance typically has a waiting period between when you obtain insurance and when your coverage begins. If you’re filing a claim with both your dental insurance provider and health insurance provider, waiting periods for coverage could potentially be a factor.       

What If I Have Dental Insurance? 

Dental insurance can be somewhat difficult to navigate. The issues can become even more confusing when health insurance is also involved. Certain treatments will be covered partially by medical and partially by dental.   

Oral surgeries, such as wisdom tooth removal, are a common example here. Typically, your health insurance policy will require oral surgery claims to be first submitted to your dental insurance company.  

If your dental policy doesn’t cover the entire procedure, then an additional claim will need to be submitted to your health insurance provider. The idea is to provide total reimbursement. However, as you can probably imagine, dealing with two different insurance companies often turns into a headache. 

Are Other Payment Options Available For Dental Care? 

Despite what health insurers seem to believe, regular visits to the dentist’s office are an important part of an overall healthy lifestyle. So you probably don’t want to rely on health insurance for your dental needs.  

While dental insurance does have many benefits, it’s not always an affordable option, especially when not provided by an employer.  

Dental discount plans are an affordable option to dental insurance. When you join a dental discount plan, you’ll receive a membership card which you can use right away. Present the membership card at any participating dentist’s office to receive instant savings. Depending on the specifics of your plan and procedures performed, discounts can range from 10% to 60%.  

Even if health insurance covers an initial emergency procedure, your dental discount card can help you afford follow-up treatments. Plus, dental discount plans have no paperwork you need to file or waiting periods to follow. 

Unfortunately, health insurance isn’t a reliable way to pay for dental care. But other options are available. Dental discount plans are an affordable way to stay healthy.          



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