Thursday, June 16, 2022

Does Dental Insurance Cover Wisdom Teeth

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Does insurance cover my wisdom teeth removal?

An oral and maxillofacial surgeon treats diseases, injuries, and defects of the mouth, teeth, jaws, face, head, and neck.

While each of these body parts is critical to your overall health, medical insurance does not always cover every service or cost. Meanwhile, dental plans include more procedures, but with an annual benefit maximum.

Health insurance pays for oral surgery as the primary payer with no yearly maximum . Then, the dental coverage coordinates benefits as the secondary payer.

The trick is getting both types to coverage to honor claims when the line between the two becomes blurry which happens often.

If Your Emergency Happened In The Past Three Months

If your dental emergency happened within the last three months, and you are eligible for Medicaid, and your state provides Medicaid dental benefits, you may be able to apply for retroactive Medicaid. This will cover your emergency dental fees, but only for bills from up to three months prior to the date of your application.

This is a very complicated process and we do not recommend completing the form for retroactive Medicaid by yourself. To get help with the process, find a Healthcare Navigator. Navigators services are absolutely free. They are extremely knowledgable about the healthcare system, and if it turns out you arent eligible for Medicaid, they might be able to connect you with other help to fund your dental emergency with no money.

To find a Navigator near you, head to this search page and type in your location. It will show results for agents, brokers, and navigators , so make sure you choose the Navigators or Assisters option.

Why Do Wisdom Teeth Need To Be Removed

You may be wondering why wisdom teeth need to be removed. For most people, wisdom teeth dont come in properly. They either come in at the wrong angle, crowd the other teeth, or dont come in at all. Wisdom teeth that dont come through the gums are often pushed up against the roots of the molars next to them, which can cause damage. The constant pressure of the wisdom teeth wears away the roots of your other teeth below the surface. They can also push your other teeth out of alignment.

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How Much Is A Tooth Extraction Insights

As indicated above, the cost of a tooth extraction can be on average anywhere from $50 to over $1,100, but how much youll actually pay will depend on whether you have dental insurance. Without dental insurance, youll be responsible to pay your entire bill out-of-pocket, but a Guardian Direct dental insurance plan can help cover a portion of your treatment costs typically up to 50-70%, subject to waiting periods and annual maximums. Learn more about how dental insurance can help you save money and how much you should typically expect to pay.

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How Important Are These Particular Molars

Does Dental Insurance Cover Wisdom Teeth Extraction ...

So many people ask why we have wisdom teeth if we dont need them? We may not need them now, but we did once upon a time. Our primitive ancestors needed wisdom teeth to chew the raw meat, tree bark, roots, nuts, and leaves that were part of their everyday diet.

Advances in cooking and meal prep have made food much softer, which means the average person doesnt need the third set of molars.

Today, the human brain is much larger than a cavemans, which means there simply isnt enough room in the human jaw for the third set of molars.

When there isnt enough room for wisdom teeth to erupt through the gum, wisdom teeth can cause many health problems including impactions, infections, and overcrowding.

To prevent these problems from becoming overwhelming, many dentists will preemptively remove the third set of chompers. If left untreated, an impacted wisdom tooth can lead to serious health conditions including death.

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The Cost Of Wisdom Tooth Removal

The basic cost of wisdom tooth removal varies according to the complexity of the procedure. This is often determined by whether the tooth is impacted or if it has fully erupted already.

Other factors that affect the cost include the level of anesthesia needed, the skill level of your maxillofacial surgeon, and the cost of living in your area.

These are typical costs associated with the procedure:

  • There is a baseline cost of at least $75 per tooth extracted, so about $300.
  • There is an additional cost of up to $200 per tooth, if you need more anesthesia, so you could spend as much as $800.
  • Nitrous oxide costs about $40 to $90.
  • Impacted wisdom teeth cost about $225 to $600 per tooth to remove.
  • Prices vary according to geographical area. Expect higher costs in places with higher costs of living. The bill can go up to $4,000 total in some places.

Dental plans typically cap what they will cover at $1,000 to $1,500, so you may get a good amount of the cost covered, as long as you have no other dental expenses in the year. This can also vary a lot by insurer. They may decide that the operation is not necessary for your overall oral health.

The average out-of-pocket cost for wisdom tooth removal, after factoring in insurance coverage, is about $641 per tooth. However, this can range from $190 to $994.

How Much Does Wisdom Teeth Removal Cost In Rockville Md

Team Oral Surgery, Uncategorized, Wisdom Teeth

Do you or your teenager/young adult need to have wisdom teeth removed? Wisdom teeth is the common name given to the third set of molars that may or may not come in around the late teenage years or early adulthood. Wisdom teeth are not really necessary for dental health or function, and they tend to do more harm than good.

Some peoples wisdom teeth come in correctly without causing any problems. But the majority of people need to have their wisdom teeth removed. The typical timeframe for doing so is between the ages of 16 and 20.

If youre a parent planning wisdom teeth removal for your son or daughter, youre probably wondering how much does wisdom teeth removal cost in Rockville, MD? Heres what you can expect.

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Does Dental Insurance Cover Braces Or Invisalign

Most dental insurance plans dont cover cosmetic dentistry. They may cover whitening if its necessary to make a tooth match the color of your existing teeth, but in general cosmetic procedures are not typically covered. Orthodontics like braces or straighteners are considered cosmetic and many dental insurance providers wont cover them. However, there are Guardian Direct plans that will cover a portion of the cost of orthodontics for covered children younger than 19 after a 12 month waiting period.

Option : Medicare Medicaid Chip

Cost of a Tooth Extraction | Teeth Extractions

Medicare does not pay for most routine dental care such as cleanings, fillings, dentures, and extractions. Medicare Part A covers some emergency dental treatment provided in a hospital.

Every state must provide Medicaid dental benefits for children enrolled in their program. Some states also offer dental coverage for adults. When examined by a physician, children might receive an oral screening, but this does not replace the required exam by a dentist.

The minimum dental care provided to children under Medicaid includes:

  • Treatment that is necessary to relieve dental pain and infections
  • Restoration of broken and decayed teeth
  • Procedures that are essential to maintain the childs oral health

The federal government partners with state governments to offer affordable health coverage for children who cant qualify for Medicaid due to their familys income. This program is called the State Childrens Health Insurance Program. It works closely with Medicaid to offer different benefits in each state.

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Why Do We Have Wisdom Teeth To Begin With

Wisdom teeth are an evolutionary vestige from our primitive ancestors. They needed the extra set of molars to help chew their hunter-gatherer diet of tree bark, raw meat, nuts, roots and leaves.

Once ancient humans became less nomadic and started to use cooking and meal preparation techniques, the food they ate became softer and easier to chew. Over time, this eliminated the need for the 3rd set of molars. Better meal preparation techniques, along with the consumption of cooked instead of raw meat, the size of the human brain increased dramatically. Our modern jaws simply donât have room for that 3rd set of molars any longer.

Most adults have between 1 and 4 wisdom teeth growing in the back of their mouths. A lucky 35% of Americans do not have wisdom teeth at all.

Does Insurance Cover Wisdom Teeth Removal

As a licensed oral surgeon, Dr. Puckett gets asked many questions about wisdom teeth removal: Does it hurt? How much does wisdom teeth removal cost? Can wisdom teeth be removed during a single visit? But the number one question we get asked is this: Does insurance cover wisdom teeth removal?

The short answer is this it depends. It varies according to each insurance plan and how much of a medical necessity removing your wisdom teeth is.

Chances are that if you are seeking to have your wisdom teeth out, youre following the advice of your dentist or oral surgeon. Most likely, the procedure is a medical necessity. Because of this, we have good news for you: Wisdom teeth may very well be covered, at least partially, by both your health insurance and your dental insurance. Your wisdom teeth removal doctor can work with your insurance company to determine if your wisdom teeth are covered by insurance and what your out of pocket fees are.

Most insurance plans offer come coverage for wisdom teeth removal. It averages 50% to 80%, depending on the quality of your plan. Youll probably be subject to deductibles and copays.

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How Much Does A Bridge Cost For 1 Tooth

Dental bridges are an affordable tooth replacement option. The cost of dental bridges varies, and with insurance the costs reduce significantly, but most patients pay between $300 and $1,000 for a bridge to replace a single tooth. Youll pay more for an all-porcelain bridge than for a metal or porcelain-fused bridge.

Does Dental Insurance Cover Wisdom Teeth Removal Yes

Does Dental Insurance Cover Wisdom Teeth Extraction ...

How much does it cost to get wisdom teeth removed when you have insurance? Well, that will depend on the plan youve signed up for, as well as how complicated the extraction will be.

With a comprehensive dental plan, you can dramatically reduce what youre required to pay out of pocket, even when you consider premiums, deductibles, coinsurance, and copays.

Whether your insurance covers 50% of the cost or as much as 80%, you can save a lot of money, especially if the procedure will cost you hundreds or thousands of dollars!


  • Remember, you might be able to save some money if you have more than one problematic wisdom tooth extracted during the same appointment.
  • If your insurance has an annual maximum and you need more than one wisdom tooth removed, you might be able to do one at a time over the course of two years to remain within coverage limits, and to save the most money possible.

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Does Delta Dental Insurance Cover Wisdom Teeth

Will Delta Insurance cover your treatment? Because the insurance plan for each family is a unique one, there isnt one simple way to answer this question. The coverage depends upon the provider, the dental surgeon, and your current location and therefore may vary with every patient. You can get more information on the subject and whether your wisdom teeth removal is covered, by giving one of our Kool Smiles Kids Club partner dentists a call today!

What Are Wisdom Teeth

Most people have four wisdom teeth. If they have room to grow in straight and aligned with the other teeth, healthy wisdom teeth can help you chew and do not need to be removed. Although you will feel some swelling and tenderness as they break through the gums the mild pain goes away when the tooth breaks through to the surface. However, if your mouth is not large enough to make room for another molar or if your wisdom teeth do not grow straight up into the mouth, you might need to have them removed. Some wisdom teeth grow at an angle and push against the roots of the other teeth. Some never grow all the way through the gums. Others develop fluid-filled sacs, called cysts, that can damage the jawbone. An impacted wisdom tooth is one that is trapped under the gums or down in the jaw. Any of these cases would require wisdom teeth removal.

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Medically Necessary Dental Services

Health insurance will cover specific dental procedures when medically necessary, which is always a judgment call made by the claims adjuster.

The definition may include dental care arising from non-biting accidents, certain diseases, and treatments deemed integral to other services included in the plan.

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  • Tips To Save Money On Dental Care

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    You shouldnt despair if you dont have access to dental insurance and lack the money to pay out-of-pocket. There are many ways you can save money on dental care, including the following methods:

    1. Participate in Medical StudiesMany universities and organizations research specific dental conditions and treatment methods. For example, clinical trials are often developed to test the quality of new treatment drugs, and in order to evaluate the drugs, researchers require volunteers. Therefore, you can consider participating in a medical study in exchange for free dental care, such as a cleaning or having a wisdom tooth extracted.

    However, you must be aware that the nature of the care you receive is often relevant to the field being studied, so be sure to find a clinical trial that is willing to provide the type of work that you require. You can find a list of clinical trials in your area via The National Institute of Dental and Craniofacial Research.

    2. Use Free or Low-Cost Dental ProvidersMany dentists provide services to patients who lack insurance, and operate on a sliding scale, meaning they will set their rates according to your income.

    If you do not locate or cant afford a dentist who operates on a sliding scale, you may be eligible to receive service from a free medical clinic. Eligibility is generally restricted to low-income patients.

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    Will I Be Awake During The Surgery Will It Hurt

    One of the biggest concerns we hear is anxiety due the recovery from the surgery. People worry about the degree of pain the will experience and how long will it take for to recover from this common procedure.

    Depending on your level of comfort and the type of impaction, an oral surgeon will administer either a local or general anesthetic. Local anesthetic just numbs the mouth area, but youâll be awake during the entire procedure. General anesthesia can knock you out for the procedure or just put you under mild sedation. Either way, you may be too drowsy to drive from the procedure. You will want to make sure you have someone available to drive to and from the office.

    Is Extracting Wisdom Teeth Worth It

    In reality, it may not be cheap wisdom teeth removal, but it is definitely worth it. Extracting your wisdom tooth as soon as it erupts , should be a priority and never to be ignored. Why? Because disregarding the first signs of an impacted wisdom tooth will only result in even more complications which includes a more expensive oral surgery in the future. Remember, an impacted wisdom tooth will never get better on its own.

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    Does Cigna Health Insurance Cover Wisdom Tooth Extraction

    Benefits covered by your Dental Plan include Preventive & Diagnostic Care such as Oral Exams, Cleanings and X- Rays. Your Plan also includes Basic Restorative Care such as fillings and simple extractions. Major Restorative Care is covered under your plan and includes Crowns, Dentures and Bridges.


    Is Wisdom Tooth Removal Effective

    Does Dental Insurance Cover Oral Surgery?

    Given the seriousness of this procedure, it is quite logical to wonder if the surgery is effective in the end. In the vast majority of cases, the removal leads to a much better overall quality of oral health, a reduction in pain, and a return of normal gum function. In many cases, wisdom teeth crowd the back teeth, causing much discomfort over time. Wisdom teeth removal can help alleviate this.

    In addition, any wisdom tooth that is impacted can cause severe problems down the road so it is best to have them removed by a trained surgeon. As the procedure can be expensive when paid out of pocket, it is helpful to first determine if your health insurance company provides coverage for the operation. There are quite a few policies that will certainly make accommodations for this medically necessary procedure.

    Wisdom tooth removal is also effective at reducing and eliminating the redness and swelling of the gum area caused by teeth that have only partially come in.

    As the tooth is not likely to come in any further, food and bacteria can get trapped underneath the gum area creating the potential for a host of serious problems down the road.

    It is important in such cases to have the wisdom teeth removed. Gum disease is a serious concern for individuals who have issues with their wisdom teeth, and removal is seen as an effective way of minimizing this risk. As wisdom teeth are difficult to clean, this situation is often compounded until they are removed altogether.

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