Does Dental Insurance Cover Crowns?

Dental work and healthcare can be expensive. Finding affordable insurance can be a daunting task. But, selecting dental insurance that covers the dental care you need and want is important. At some point, many patients need a dental crown to keep a tooth and maintain the correct shape of their mouth and the appearance of their smile. In this article, we at Hamby Family Dental Center, your Fuquay-Varina dentist, provide information on what getting a dental crown involves and explore the coverage dental insurance applies to dental crowns.

What is a Dental Crown?

A dental crown is a cap that is placed on top of a damaged tooth. A crown protects, covers, and restores the shape of a tooth when a filling isn’t the solution. Crowns can be made out of a variety of materials including:

• Porcelain
• Resin
• Metal
• Ceramic
• Stainless steel
• Silver or gold
• Porcelain-fused-to-metal (PFM)

A crown doesn’t require special care other than regular good oral hygiene. If you are getting a root canal or dental implant, a crown will be used to cap the artificial tooth. Dental crowns are typically custom-made to specifically fit the shape and size of the tooth and then cemented to remain in place.

Costs for a Dental Crown

There is no set or standard cost for a dental crown. The price is relative to the materials that are used. Crowns are made of natural materials that are extremely durable instead of cheap plastic. The dentist requires expertise in fitting a crown properly. Other factors that contribute to the cost of a crown are the type of restorative work that is required and the location of the tooth. In general, crowns for front teeth are more expensive because they require more time during installation in order to achieve a natural appearance. The range of costs is between $500 and $3,500 per tooth. Metal and stainless steel crowns are the cheapest, have the least durability of other options, and do not look as natural as some other crowns. Porcelain and ceramic crowns appear the most natural, are long-lasting, but can be more expensive.

Dental Insurance Coverage for Crowns

Most dental insurance plans cover a set of dental procedures, including:

• General dentistry checkups and cleanings
• Fillings, if not made of gold or silver
• Root canal procedures
• Extractions
• Crowns for damaged teeth that would otherwise be extracted
• Dental implants

Most crowns are covered by dental insurance–but not all crowns. The discriminating factor in whether insurance covers the procedure is if the crown is done for health reasons. If so, dental insurance will meet part of the cost. However, if the crown is for cosmetic reasons, the chance that insurance will cover the crown is very small. A tooth must exhibit a significant structural loss from decay or fracture to be covered by dental insurance. For example, crowns that cover weak, cracked, or large cavities are covered by insurance. Crowns that are to restore and repair lesions due to wear, attrition, abrasion, and abfraction are not typically covered. Most of the time, if the periodontal health of a tooth is impaired, the long-term prognosis of keeping the crown is not good and the chances of insurance denying the claim is strong.

Level of Coverage

If you have a full-coverage dental insurance plan, it will usually pay for 50% of the cost of the procedure and the patient is liable for the rest. Most dental plans that offer major restorative dental care will cover dental crowns. Some plans limit coverage to preventive care and basic procedures such as dental fillings and tooth extractions. Many plans have a waiting period of up to one or two years after the purchase of the insurance relative to crowns.

Types of Dental Insurance Plans

Dental plans can be divided into three broad categories:

Preferred Provider Organization (PPO)

A PPO dental plan provides a list of in-network dentists that accept the plan. If you choose a dentist that is outside of the network, you have to pay more out of pocket.

Dental Health Maintenance Organization (DHMO)

A DHMO dental plan also offers a network of dentists that usually cover a percentage of the cost of restorative work like crown; however, you may need to be referred by your primary care dentist.

Discount or Referral Dental Plan

With this type of plan, the costs of a crown will not be covered, but the group of dentists who accept the plan may give you a discount on the services.

Contact Us Today for Recommendations When Needing a Crown

Our professional dental team can assist you with recommendations for dental plans that cover your dental care. We work with you to get and keep a healthy smile! Contact us today for a teeth cleaning and checkup so we can help you prevent or correct oral issues you may have. Call us at 919-552-2431 or fill out the form below.