In our Toronto cosmetic dentistry clinic we get a lot of questions about dental insurance. People are often unclear about how dental insurance works and what it covers. One of the biggest questions we are asked is, “does insurance cover cosmetic dentistry?”
The answer to this question varies. Cosmetic dentistry covers a lot of procedures with a variety of purposes. As a result, what is covered and how much is covered depends on a few things. These include:
Some cosmetic dental procedures are more eligible for coverage than others. Teeth whitening and gum shaping, for example, are almost never covered. But, here are a few procedures that are sometimes eligible for coverage or partial coverage.
Fixing chipped teeth receives some coverage in most plans. Procedures like dental bonding, crowns, and veneers are popular solutions.
Porcelain veneers are becoming more common to include in dental insurance plans. They have a number of cosmetic and oral health benefits for many patients.
Dental implants are one of the best ways to fix gaps in your teeth. However, many insurance plans exclude them, instead offering other solutions such as partials or dentures.
Most plans that offer full or partial coverage for braces are only for people under 18. Adults will often turn to braces alternatives like Invisalign. Some dental insurance plans cover anywhere from $500 to $3,000 for Invisalign treatment.
Which cosmetic dentistry options your insurance covers, and how much they cover generally depends on the reason for the procedure. Most plans require procedures to offer a clear medical benefit.
Teeth whitening, for example, is so rarely covered because the results are purely cosmetic. Treatments for restoration or prevention of dental issues are more commonly covered. Pain, infection, restoring tooth structure, and oral health are higher priorities for dental insurance.
Regular visits, cleanings, and fillings often receive full coverage. These are preventative or simple procedures that help maintain your oral health. The more complex the solution, the less likely your insurance will cover it.
Your cosmetic dentist may recommend a treatment your plan doesn’t cover. In this case, they can suggest alternatives as well. However, your dentist is generally more concerned with what is best for you than your insurer is. With good reason for a treatment the insurance company may be willing to cover up to a certain cost, or cover the cost they would have for the cheaper alternative. It’s worth checking out; no one wants to settle for a lesser smile.
There is no universal rule for what or how much dental insurance covers. This is dictated by your specific dental plan. There are, however, some commonalities amongst most dental insurance plans.
For one, insurance is intended to alleviate dental costs - not to cover them completely. Dental exams are sometimes covered in full, but in many cases cosmetic dentistry only gets up to 50% coverage. This does vary depending on your insurance plan.
More expensive plans generally cover more. As well, fixed rate plans may offer coverage up to a specific dollar amount that you can use as you choose.
Another general truth is that most dental insurance plans are, “use it or lose it.” Plans reset each year, unused dental does not carry over to the following year.
OHIP doesn’t typically cover dental work. However, there are assistance plans for dentistry in Toronto. Ontario Works & Ontario Disability Support both offer some dental coverage if you meet their requirements.
For Toronto patients, Dr. Judy Sturm & Associates offer cosmetic dentistry financing options in their Yorkville clinic.
Nationwide, Canada offers a Dental Tax Credit. On large bills, this can add up to receiving as much as 20% of the cost back in tax credits. Other dental expenses like fillings, dentures, and implants can be filed as medical expenses if your insurance didn’t cover them.
Generally, medical insurance is separate from dental insurance. In most instances cosmetic dentistry cannot receive coverage from medical insurance. However, there are some exceptions.
Gum contouring, for instance, is sometimes covered by medical insurance. Although this is a cosmetic dental procedure it rarely receives dental coverage. Your cosmetic dentist is aware of many of these sorts of options. If there is a procedure you want to get that you insurance doesn’t cover, be sure to get a consult to discover your options.
Looking for a cosmetic dentistry consult in Toronto. Dr. Judy Sturm is a multi-time winner of the audience-voted Best Dentist in Toronto Award. Contact Judy today to set up a dental appointment in Toronto’s Yorkville district.
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