When Does Medical Insurance Cover Dental Work?

When Does Medical Insurance Cover Dental Work?

When you’re experiencing a medical emergency, the thought of paying for emergency dental work with or without dental insurance can sometimes deter you from seeing a dentist. But, did you know that medical insurance will often cover dental work in certain situations? It’s true! At Center City Emergency Dentist, your local source for emergency dental service, we understand that costs are a concern. Discover the most common situations in which medical insurance pays for dental work.

Medical Insurance vs. Dental Insurance: Who Pays?

Though all plans differ, dental insurance typically covers routine dental care needed as a result of normal wear and tear or bite-related conditions affecting teeth. Covered services may include non-urgent X-rays, exams, and cleanings in addition to fillings, crowns, and bridges. In limited circumstances, dental insurance may also provide coverage for braces or implants.

Unlike dental insurance, medical insurance will only cover dental work if you’ve sustained trauma, such as an accident or injury, or have a medical condition that affects your mouth. In all cases of dental work covered by medical insurance, the reason for the visit needs to be medically necessary and fall under the medical plan’s rules for coverage. Here are examples of dental work covered by some medical insurance plans.

Dental Work After Trauma

Whether you’re in an accident that results in teeth being broken or the unfortunate victim of violence, covered dental work needed after a traumatic event will usually fall under the scope of your medical plan. It’s important to note that if your accident involved a motor vehicle, dental work may instead be covered under auto insurance. In this case, it’s best to speak with an insurance specialist or your health plan to determine which plan has primary responsibility for related dental care.

Medical Conditions Affecting Teeth or the Mouth

Certain medical conditions or treatments, such as radiation therapy for cancer patients or a medical condition of the temporomandibular joint (TMJ), may be covered by medical insurance instead of dental insurance. Conditions that affect your dental (and overall) health are usually considered medical reasons for seeking dental services and may be payable under your health plan.

Let Us Help You

Navigating the complex landscape of insurance isn’t something you should have to do alone. Our team at Center City Emergency Dentist is well-versed in dental and medical insurance requirements and can help you obtain benefit information specific to your plan. As your 24-hr dentist, we’re here when you need us most. Contact us today!