Does Insurance Cover Veneers?

Insurance coverage for veneers largely depends on the reason for getting them. If veneers are considered cosmetic, most dental insurance plans do not cover them.

If they’re deemed necessary for structural reasons or to correct a dental health issue, you might receive partial coverage.

When are veneers covered by insurance?

Dental veneers are generally considered a cosmetic procedure, so most insurance plans won’t cover them.

There are some exceptions, though:

• Medical necessity: If the veneers are deemed medically necessary to restore the function or structure of your teeth, your insurance may cover some or all of the cost. This could be the case if you need veneers to repair cracked or chipped teeth, severe wear and tear, or teeth that are misaligned in a way that affects your bite.
• Replacing existing restorations: If you have existing crowns or veneers that are damaged or worn out, and need replacing, your insurance might cover some of the cost, especially if the dentist can justify it as medically necessary.

Here are some things to keep in mind:

• Every insurance plan is different: What one plan covers may not be covered by another. It’s important to carefully review your dental insurance policy or contact your provider to see what types of procedures are covered.
• Documentation is key: If you believe your veneers may be covered for medical reasons, your dentist will need to provide documentation to your insurance company to justify the treatment. This could include X-rays, photographs, and a detailed explanation of why the veneers are necessary.

Even if your insurance doesn’t cover the entire cost of veneers, it may still help to offset some of the expense.

Talk to your dentist about your options and whether they can work with your insurance company to get you the coverage you need. (Read more: How To Get Dental Insurance Without A Job)

Does dental insurance cover veneers differently depending on your plan?

Absolutely, dental insurance coverage for veneers can vary significantly depending on your specific plan. Here’s why:

• Definitions of “medically necessary” differ: Insurance plans have varying definitions of what constitutes “medically necessary” treatment. Veneers are primarily cosmetic, but if there’s a functional reason (chipped tooth, misalignment affecting bite), some plans might cover a portion of the cost under this category.
• Coverage percentages fluctuate: Even if your plan deems veneers necessary in certain cases, the coverage percentage can differ. One plan might cover 50%, another 70%, and some might not cover them at all.
• Out-of-Network vs. In-Network: HMO plans typically restrict coverage to in-network dentists, so out-of-network veneers likely won’t be covered. PPO plans might offer some coverage for out-of-network providers, but it’ll usually be less than in-network.
• Waiting periods: Some plans, especially for expensive procedures, may have waiting periods before certain treatments are covered, even if deemed medically necessary.
• Type of dental insurance plan: There are various types of dental insurance plans, such as Dental Health Maintenance Organizations (DHMOs), Preferred Provider Organizations (PPOs), and indemnity plans. PPOs and indemnity plans are more likely to offer some level of coverage for out-of-network care, which could apply to veneers, while DHMOs typically restrict coverage to in-network providers only.
• Specific plan provisions: Even within the same type of plan, coverage can vary. Some plans might exclude all forms of cosmetic dentistry, including veneers, while others might offer coverage under certain conditions or offer cosmetic dentistry riders for an additional premium.
• Annual maximums: Dental plans often have an annual maximum benefit limit. If veneers are covered, the cost can quickly consume this limit, affecting coverage for other dental work within the same coverage year.
• Deductibles and co-payments: The specifics of deductibles (the amount you pay out-of-pocket before your insurance starts to pay) and co-payments (a fixed amount you pay for a covered service) also affect how much you end up paying for veneers, even if they are covered.
• Pre-existing condition clauses: Some plans might not cover conditions that were present before you enrolled in the plan, which could apply to cosmetic issues corrected by veneers.

How to find dental veneers covered by insurance

Finding dental veneers covered by insurance involves a few steps, given that veneers are often categorized as a cosmetic procedure and coverage can vary significantly among insurance plans.

Here are steps you can take to determine if your dental insurance might cover veneers, and to what extent:

1. Review Your Insurance Policy Details

• Read the policy: Look for the sections on cosmetic procedures, exclusions, and conditions for coverage of restorative procedures. This will give you a clear understanding of whether veneers might be covered and under what circumstances.
• Check for specific provisions: Some plans may cover veneers if they are deemed medically necessary (e.g., to restore a tooth’s function or in case of injury). Determine what criteria must be met for a procedure to be considered medically necessary.

2. Contact Your Insurance Provider

• Customer service: Reach out to your insurance company’s customer service department to ask about coverage for dental veneers specifically. Be prepared to describe why you need the veneers, as this can affect coverage.
• Ask for a predetermination of benefits: This is a formal process where your dentist submits a treatment plan to your insurance company before the work is done. The insurance company then provides a written statement of how much of the procedure will be covered, which can help you understand your out-of-pocket costs.

3. Discuss with Your Dentist

• Consultation: Your dentist can provide an assessment of whether veneers are the best option for your dental needs and whether the procedure might be covered by insurance as a medically necessary service.
• Documentation: If veneers are recommended for medical reasons, your dentist can help document this necessity to increase the likelihood of insurance coverage. They can also assist with the predetermination of benefits process.

4. Explore Alternative Coverage Options

• Cosmetic dentistry riders: Some insurance plans offer optional coverage for cosmetic procedures, including veneers, for an additional premium. Check if your plan has such options.
• Flexible Spending or Health Savings Accounts: While not insurance, these accounts allow you to pay for certain medical and dental expenses with pre-tax dollars, which can include veneers in some cases.

5. Consider In-Network Providers

• Maximize coverage: If your insurance plan does provide some coverage for veneers, using an in-network provider will usually maximize this benefit, reducing your out-of-pocket costs.

6. Look for Special Programs or Discounts

• Dental discount plans: Some dental discount programs offer reduced rates on cosmetic procedures, including veneers, with participating dentists. These are not insurance plans but can help lower costs.

Remember, the key to finding out if veneers are covered under your dental insurance is to thoroughly understand your policy, communicate clearly with both your insurance provider and dentist, and explore all available options to minimize your expenses.

What to do if you can’t afford dental veneers

If dental veneers seem out of reach due to their high cost, there are several alternatives and strategies to consider that can help achieve a similar aesthetic improvement or manage the expense.

Here’s what you can do if you find that you can’t afford dental veneers:

Explore Payment Plans and Financing Options

Many dental offices offer payment plans that allow you to spread the cost of treatment over several months or even years.

Dental financing through third-party companies can provide manageable monthly payments, sometimes with low or no interest for a promotional period.

Consider Dental Schools

Dental schools often provide services at a significantly reduced cost. Treatment is performed by dental students under the supervision of experienced dentists. While it might take longer, the savings can be substantial.

Look Into Dental Discount Plans

Dental discount plans are not insurance but offer reduced rates on many dental services, including cosmetic procedures, for an annual fee. They can provide significant savings at participating dentists.

Investigate Alternative Treatments

• Dental Bonding: A less expensive option, dental bonding involves applying a tooth-colored resin to the tooth to improve its appearance. It’s less durable and less dramatic than veneers but can significantly enhance your smile at a lower cost.
• Teeth Whitening: If discoloration is your main concern, professional teeth whitening might offer a satisfactory improvement for a fraction of the cost of veneers.
• Orthodontics: For alignment issues, braces or clear aligners can correct teeth positioning, improving the appearance without covering the teeth with veneers.

Save Up for the Treatment

It might be worth saving up for veneers if no other treatment will satisfy your needs. Setting aside money in a savings account or through a health savings account (HSA), if eligible, can help you manage the cost over time.

Consult Multiple Dentists for Quotes

Prices for dental veneers can vary widely between dentists due to factors like location, the dentist’s experience, and the materials used. Consult with several providers to find the best price and payment options that suit your budget.

Use Flexible Spending or Health Savings Accounts

If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), you might be able to use these funds to pay for part of your treatment, thereby using pre-tax dollars to save money.

Prioritize Your Dental Needs

If you need multiple dental treatments, discuss with your dentist which procedures are most urgent. It might be possible to spread out treatments over time to make the costs more manageable.

Check for Charitable Organizations and Grants

Some organizations offer assistance for dental treatments through grants or reduced-cost services for those in need. These might be more focused on essential dental work but are worth investigating.

FAQ on Does Insurance Cover Veneers?