Are Dental Crowns Covered by Insurance?

Dec 01, 2022

Dental crowns in Aurora, ON help cover, damaged, decayed, and discolored teeth to restore their strength, functionality, and appearance. The restorations are beneficial to hide your damaged or discolored tooth from view to help you enjoy your natural tooth for as long as possible.

Dental crowns are not affordable restorations to fix defects with your teeth, and you might consider getting your dental insurance provider to contribute towards the tooth repair you need. However, we suggest you might find it beneficial to discuss tooth crowns with a provider in your locality and your dental insurance company to determine whether they will contribute towards the repair of your tooth. You would not want to end up in soup after getting your tooth fixed to realize that your insurance provider is leaving you high and dry, would you? Therefore you must collect all information about the dental crown procedure, the material of the dental crown, and all necessary information before contacting your insurance company to determine whether they cover the costs.

What Does Dental Insurance Generally Cover?

Dental insurance offers maximum coverage of specific dollars related to procedures for the health and wellness of the patient. Insurance providers follow a three-tier structure which they term 100-80-50.

Insurance providers offer coverage of 100 percent for preventive care such as twice-yearly exams and cleanings, x-rays and dental sealants. Procedures like dental fillings, tooth extractions, and periodontal disease treatment receive 80 percent coverage towards the expenses. Significant procedures like dental crowns, bridges, dentures, and inlays receive 50 percent coverage, depending on whether you need them for health or aesthetic reasons. Most insurance plans are divided into three categories: preventive, essential, and major. Insurance providers focus on preventive and basic care, while major procedures do not receive full coverage.

If you need to receive endodontic therapy, which also requires you to have a dental crown to protect the weakened tooth from further breakage, your dental insurance considers the root canal as a primary or major procedure, indicating you might receive some reimbursement from the provider towards the treatment but would have to inquire whether they also contribute towards the dental crown. Therefore it helps to discuss with your insurance provider about your plans to fix your teeth by visiting dental crowns in Aurora, ON, or visiting them directly to inquire whether they accept any dental insurance when restoring your tooth.

How Much is Dental Crown with Insurance?

If you have a weak or cracked tooth expect your dental insurance provider to cover the cost of your dental crown because you need the restoration to repair a tooth and potentially avoid a health problem. However, if you decide to get expensive porcelain crowns for aesthetic reasons to hide a discoloured or misshapen tooth, your insurance provider might surprise you with the information they don’t cover cosmetic procedures.

Dental insurers are particular about not covering any teeth restoration procedures that help improve the appearance of your teeth for aesthetic reasons like your smile instead of your dental and general health. Instead, insurance providers are specific about whitening treatments, veneers, dental bonding, and adult orthodontics with Invisalign. However, if you discuss your needs with dentists in Aurora, ON, you might discover a technique to get around the problem of adult orthodontics with Invisalign by convincing insurance companies that you are receiving orthodontic treatment to straighten teeth for health reasons.

The Cost of Dental Crowns Determines the Coverage

Different materials help make dental crowns suitable for fixing teeth. These restorations are helpful for various purposes besides covering damaged, discoloured, and misshapen teeth. Dental crowns also replace natural teeth when dental implants or bridges are provided. However, dental insurers consider the material of the dental crown before determining the cost or the coverage they offer.

For example, you might receive partial coverage for a dental implant procedure involving surgery to insert a titanium post into your jawbone. However, dental insurers might refuse coverage for the dental crown that becomes necessary to function as your artificial tooth.

The prices of dental crowns vary considerably, and you might receive 50 percent of the coverage for fixing your tooth and prepare to pay for the rest out of pocket. However, please remember the 50 percent coverage might not apply if you seek restorations to fix your teeth for cosmetic reasons. Therefore, before considering dental crowns, you must discuss your needs with the Aurora provider, discuss your coverage with your dental insurer, and get your tooth fixed as needed using the appropriate material for the dental restoration.

If you must get dental crowns to fix teeth, we suggest you visit Aurora Dental Studio with your dental insurance papers to discuss the entire treatment process and costs. The practice also accepts most dental insurers and can guide you on how much the procedure coverage your insurance provider will contribute towards the restorations you need.

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