Does Insurance Cover Dental Fillings? On Cavities, Dental Visits, and Insurance

Does Insurance Cover Dental Fillings? On Cavities, Dental Visits, and Insurance

Suppose you get a checkup and the dentist discovers cavities. You need to get them filled to prevent further tooth decay. The procedure is not too costly, but you cannot pay out of pocket right now. Does insurance cover the cost of dental fillings? It all depends on what kind of insurance is under discussion.

Dental Insurance for Cleanings and Fillings

Most insurance companies sell a separate dental insurance policy or dental policy. This is insurance that specifically covers dental work. It typically costs you in addition to health insurance.

Most dental insurance policies will cover regular checkups and cleanings twice a year. Some will require you to pay some money out of pocket, although the policy will pay most. Also, most dental insurance plans will also cover the majority of expenses related to cavity fillings. They should also cover other expenses related to dental work, such as X-rays, root canals, and sealants.

That said, different dental policies might cover some types of fillings and filling procedures but not others. For example, most fillings are done with silver amalgam. But, these days, people can get fillings with a tinted composite as well. A policy might cover fillings with amalgam, but not composite, so you would have to pay extra if you wanted the composite fillings.

Will Regular Health Insurance Cover Fillings and Other Dental Work?

Unless you work somewhere with good benefits that include dental insurance (or you had the foresight to buy extra insurance on the market), you probably don’t have a separate dental plan. But many dental patients ask our dentists whether normal health insurance will cover some dental procedures.

This is a tricky question, and the answer varies depending on the particular insurance company you have. Generally, there are many health insurance plans that will cover dental procedures deemed “medically necessary.” That is, the underlying problem has to be one that the insurance company considers a medical problem.

So what do insurance companies consider medical problems? Although there is no one single definition, the decision usually comes down to whether there is 1) unbearable pain, or 2) loss of function or dysfunction. So, for example, if you have problems chewing because of a misaligned jaw, you could get braces or Invisalign covered.

By these criteria, most fillings will not be covered by most health insurance.

The one exception might be if you purchased a plan through a state exchange under the Affordable Care Act (aka Obamacare). Health care plans on those exchanges must, by law, include dental coverage for children. So, if you bought on an exchange and are seeking to pay for fillings for your children, ask your plan administrator—it might be covered.

To summarize, most general health plans will not cover fillings, but it does not hurt to ask.

But How Much Do Fillings Cost?

Naturally, how much fillings cost will depend on the area of the country you live in and the experience your dentist has (as well as the condition of your teeth).

While this makes it hard to give exact costs, you can get a sense of what’s reasonable by looking at national averages:

Amalgam silver: $132

Resin composite (limited color matching): $163

Gold crown: $1,123

Porcelain/ceramic fillings: $815

You can see more precise ranges, and more options for payment, in our article “How Much Does it Cost to Get a Cavity Filled?

What Else Can You Do?

If you have no insurance, or your insurance does not cover fillings, there are other options you can consider. For example:

Negotiate with your dentist. If your dentist knows you do not have insurance, he or she might be willing to give you a price break, especially if you need multiple fillings. Some dentists might even consider a “skill in trade” arrangement if you are short on cash but can offer some services in exchange.

Ask about payment plans. Some dentists will allow you to split costs into two or three payments—a much better option than putting the bill on your credit card and paying a high interest rate!

Find a new dentist. Many folks love their dentist. Unfortunately, some dentists in independent practices end up charging way too much to keep their offices open. If you consistently get sticker shock from your current dentist, you might need to shop around. You can use our online tool to start your search and find a reputable dentist near you.