Does Dental Insurance Cover Cosmetic Dentistry?

The Difference between Restorative and Cosmetic Dentistry

While restorative dentistry is medically necessary, dental insurance companies consider cosmetic dentistry as elective. For this reason, dental insurance covers medically-necessary dental procedures differently than they cover cosmetic dentistry procedures. Insurance will usually cover some or all of your restorative procedures but will not cover elective procedures. However, many cosmetic dentists use restorative procedures, such as porcelain crowns, tooth veneers, and dental implants for restorative AND cosmetic purposes. So what makes a procedure restorative versus cosmetic?

Dental insurance considers a procedure restorative if:

  • Medically necessary due to decay or disease
  • Medically necessary due to accident or injury
  • Used for purposes other than aesthetics, such as to replace missing teeth or alter mechanics of the patient’s bite

A procedure qualifies as cosmetic or elective if:

  • The procedure exists solely for enhancing the aesthetics of the patient’s smile
  • The underlying tooth or tissue is not injured, impaired, or decayed
  • There is no medically necessary reason for altering the tooth or performing the procedure

Will dental insurance cover cosmetic dentistry procedures?

Dental insurance will usually not cover cosmetic dentistry procedures that have absolutely no medical necessity. But different situations blur the line between medically-necessary dentistry and purely cosmetic dentistry. For example, sometimes a patient needs dental work because he or she was involved in an accident. If they want the final result to be aesthetically appealing, does that qualify as restorative or cosmetic dentistry? We say both! Because the patient had a medical need for replacing teeth, the procedure qualifies as a restorative procedure. But why should that mean that the patient can’t have a beautiful cosmetic result as well?

Dental insurance may cover cosmetic dentistry if medically necessary. This patient fell from a ladder and needed restorative procedures.

After falling from a ladder, this patient’s cosmetic dentistry was partially covered by dental insurance.

Here at the Texas Center for Cosmetic Dentistry, we believe that EVERY restorative procedure should be done with cosmetic appeal in mind. For this reason, we encourage every patient to be very selective when having dental work done. Whether you are in need of restorative procedures or are just interested in cosmetic procedures, you need to find a dentist that will work with the end result in mind. We would highly recommend reading our article on how to choose a cosmetic dentist if you are thinking about having work done.

Here are a few situations in which dental insurance might cover a beautiful cosmetic dental procedure:

  • Beautiful crowns or veneers are placed by a cosmetic dentist to restore diseased, injured, broken, or missing teeth
  • Gum contouring is performed as part of a medically-necessary periodontal surgery due to infection or injury
  • Orthodontia is placed to correct shifting of teeth due to accident or injury
  • Many other example where an aesthetically-pleasing procedure is performed for medically necessary purposes

Check your insurance benefits to see what’s covered

The majority of insurance plans will not cover the following procedures:

  • Bleaching or tooth whitening
  • Correcting a space between the teeth when not cause by accident, injury, or disease
  • Initial placement of porcelain veneers if not medically necessary

That being said, you might be covered for cosmetic, whitening, and/or orthodontic services if your employer or group purchased these optional benefits for your insurance plan. To find out if your benefits include these procedures, a good place to start is with your benefits administrator, Contract or Evidence of Coverage booklet from your respective Human Resources Department.