Wisdom teeth, also called the third molars, normally appear between the ages of 17 and 25. Unfortunately, they often lack enough space in the jaw to come through correctly, resulting in problems such as impaction, infection, and damage to adjacent teeth. Wisdom tooth removal is a routine surgical procedure with numerous extractions done annually in the U.S.
Around 85% of people will have to extract their wisdom teeth at some point, according to the American Association of Oral and Maxillofacial Surgeons.
Wisdom teeth extraction is important for oral health but insurance coverage can be difficult to navigate. In this blog, we’ll examine dental and health insurance coverage for wisdom tooth removal so that you understand what’s covered and how much you may need to pay. Does health insurance cover wisdom teeth removal? Here’s everything you need to know.
Does Health Insurance Cover Wisdom Teeth Removal?
Coverage for dental procedures, including wisdom tooth extraction, varies depending on the type of insurance one has. While a regular visit to the dentist or procedures like cleaning or fillings may be covered by a dental policy, a healthcare plan usually takes care of major procedures.
Role of Dental Insurance in Wisdom Teeth Removal
Usually, wisdom teeth removal is regarded as a dental procedure; thus, dental insurance has the primary responsibility of covering it. Most dental insurance covers some expenses related to this particular problem, particularly when it’s needed medically. Here is what you may expect your dental plan to pay for.
Coverage for Wisdom Teeth Extraction:
- Medically Necessary Extractions: In cases where pain, infection, or other complications arise from wisdom teeth, there are chances that dental insurance will cover their extraction. This includes situations where such teeth pose damage to nearby ones.
- Preventive Extractions: However, even in the absence of relevant symptoms, certain preventive steps can be taken by one’s dental insurers towards removing wisdom teeth. This step is mainly meant to prevent future issues.
Out-of-Pocket Costs for Wisdom Teeth Removal
Nevertheless, out-of-pocket costs still exist that may pertain to having wisdom teeth removed while insured by a given company that is affiliated with dentistry. Different factors result in different costs.
- Dental Insurance Plan: The coverage levels offered by various types of plans differ considerably and therefore some may have fixed rates for getting rid of them while others only offer percentage-based protection. Specific information regarding your plan will enable you to budget better for these expenses since they are unpredictable.
- Provider Charges: This can also affect out-of-pocket expenses and it’s essential to acquire quotes from various providers before planning for the operation.
Estimating Your Potential Costs
The best way to estimate your potential out-of-pocket costs for wisdom teeth removal is to:
- Review your Dental Insurance Plan Documents: Look for details about wisdom teeth removal coverage, which include but are not limited to, benefit limitations as well as any exclusions mentioned.
- Get Quotes from Oral Surgeons or Dentists: Once you know the provider’s fees, you can estimate your possible out-of-pocket expenses taking into account your estimated insurance coverage.
Conclusion
Wisdom tooth extraction may be necessary for one’s oral health. Knowing how dental insurance contributes to such expenses will help you be financially ready.
You can understand your expenses after reviewing your dental plan, contacting your insurance provider, and getting quotes from oral surgeons or dentists. In addition, some plans have maximum annual benefits.
Hence, it makes sense to time such procedures to get maximum benefit. If you need assistance finding the right dental insurance plan, consider using platforms like Beem to compare quotes and make an informed decision.
FAQs
Is wisdom teeth removal a qualified medical expense?
Wisdom teeth removal may be considered a qualified medical expense if it is deemed medically necessary by a healthcare professional. However, coverage can vary depending on the specifics of your insurance plan and the circumstances surrounding your procedure.
Is out-of-network wisdom teeth removal covered by insurance?
Coverage for out-of-network wisdom teeth removal can vary depending on the specifics of your insurance plan. In some cases, insurance plans may provide limited coverage for out-of-network providers, while in other cases, patients may be responsible for a larger portion of the costs associated with out-of-network care.
When is wisdom teeth removal covered by insurance?
Wisdom teeth removal may be covered by insurance if it is deemed medically necessary by a healthcare professional. Factors such as the patient’s age, the presence of symptoms or complications, and the impact on oral health may influence whether insurance will cover the procedure. It’s essential to consult with your insurance provider and healthcare professional to determine your coverage eligibility.
