Table Of Contents
-
Understanding Night Guards and Their Importance
-
Do Dental Insurance Plans for Night Guards Cover the Cost?
-
Navigating the Fine Print: Does Insurance Cover Night Guards for Everyone?
-
How to Maximize Your Dental Insurance for Night Guards
-
How ALIGNERCO Makes Night Guards Affordable
-
HSA/FSA and Dental Insurance Plans for Night Guards
-
Is Night Guards Insurance Worth It?
-
FAQs
Teeth are a cornerstone of health, and the night guards are a key contribution to protecting teeth against grinding and clenching in sleep (bruxism). If you're interested in preserving your teeth from damage, eliminating jaw pain, sleeping better, or any combination of the above, night guards are the answer. However, one of the most common questions people ask is, "Do dental insurance plans cover night guards?".
In this blog, we will discuss the coverage choices, how night guard dental insurance works, and how affordable alternatives such as ALIGNERCO can get you the protection you need without spending a fortune.
Understanding Night Guards and Their Importance
For some, night guards are a veritable gold standard of dental care, preventing teeth from incurring catastrophic damage and saving patients from paying big bucks for dentistry down the road. But as common as night guards are, they are also quite pricey, especially when fitted by a dentist. Here are some reasons why night guards are used:
- Tooth wear and fractures
- Temporomandibular joint (TMJ) disorders
- Jaw pain and headaches
- Sleep disturbances
Do Dental Insurance Plans for Night Guards Cover the Cost?
It depends on your specific dental insurance plan. Dental insurance plans differ widely from one provider and plan to the next, and it is important to check your policy carefully before buying a night guard.
Type of Plan
- Preventive care - cleanings, X-rays, routine checkups - is always 100 percent covered by insurance.
- Restorative care - includes more complex procedures like fillings, crowns, and root canals. Night guards are generally considered to be restorative, but some plans will code them as preventive because they prevent future harm.
Medical Necessity
In all but the rarest of circumstances, dental insurance companies require a letter of medical necessity for a night guard so they will pay for it. If your dentist recommends a night guard for bruxism or TMJ disorder, they should also provide a written explanation.
- Diagnostic evidence: Insurance companies are also going to require X-rays or other diagnostics, including imaging, showing the condition of teeth from grinding.
- Letter of medical necessity: It's an article your dentist can write about regarding the need for the bite guard and how the bite guard will prevent future dental issues.
Annual Maximum Limits
Nearly all dental plans have an annual maximum, which is the maximum that the insurance company will pay in a calendar year for covered services. And night guards aren't exactly a bargain, either, as they which can run up to $1,000, depending on whether they are custom-fitted or over-the-counter. And, if you've exhausted your annual allowance for other treatments, the insurance might not cover the night guard completely.
Waiting Periods
Some dental insurance plans, including night guards, have waiting lists for restorative work. That means you may have to be on plan for a certain duration (usually six to twelve months) before you can get covered for a night guard.
Coverage Percentage
Even if your teeth insurance pays for night guards, it could only pay for half of the bill. For instance, according to plan details, most dental insurance plans cover up to 50 percent to 80 percent of custom night guards.
Navigating the Fine Print: Does Insurance Cover Night Guards for Everyone?
While many dental insurance plans offer coverage for night guards, the details often depend on your specific policy. Here are some key considerations:
Exclusions
Some plans do not cover dental appliances, like night guards. These exclusions could be restricted to certain types of guards (for instance, custom-fitted versus off-the-shelf) or could exclude night guards entirely.
In-Network vs. Out-of-Network
If your dental insurance doesn't cover a provider outside the network, you'll need to make sure the dentist or specialist who creates your night guard is in your network. Night guards are covered under your plan, but out-of-network providers could mean higher out-of-pocket expenses.
Replacement and Repair
Insurance plans often restrict coverage to one night guard per defined period (e.g., every two to five years). And if it does, then your night guard will wear out more quickly, and you'll be responsible for the repairs or replacements.
How to Maximize Your Dental Insurance for Night Guards
Review Your Policy: Start by carefully reviewing your dental insurance policy. Google for 'dental appliance coverage' or 'night guard' or 'TMJ’.
Get a Pre-Authorization: Before buying a night guard, have your dentist file a pre-auth to your insurance. This is going to be a great way for you to see what to expect and what you'll need to know.
If your insurance insists on it, then get your dentist to write up the paper that says the night guard is medically necessary.
Inquire About Payment Plans: If your insurance covers part of the cost, ask your dental provider if they offer payment plans to spread out any remaining balance over time.
Consider Affordable Alternatives: For those whose insurance plan covers only a small amount or nothing at all, cheaper alternatives are an option, such as ALIGNERCO, which sells night guards for a fraction of what you'd pay at a regular dentist.
How ALIGNERCO Makes Night Guards Affordable
When insurance coverage is limited, finding an affordable solution for a night guard is essential. ALIGNERCO, a well-known at-home clear aligner company, sells night guards for an excellent price and quality. Here’s how they can help you save money:
Affordable Pricing
ALIGNERCO does night guards at good prices so everyone can have access to them. These night guards fit your teeth perfectly, along with providing enhanced comfort and treatment.
Insurance Reimbursements
ALIGNERCO makes it easy to claim insurance reimbursement. They provide you with all the receipts and documentation you need to bring to your insurance company and have the night guard covered. And you might be able to do this even if your insurance doesn't pay for your entire bill, which could save you a bundle on out-of-pocket costs.
HSA/FSA Payments
Even if you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), ALIGNERCO honors them as a form of payment, allowing you to pay for your night guard with pre-tax dollars.
Easy Ordering Process
ALIGNERCO’s ordering process is simple and convenient. Using their at-home kit, you create your dental impressions at home, send them back, and receive your custom-fitted night guard by mail.
HSA/FSA and Dental Insurance Plans for Night Guards
Most people have an HSA or FSA with their employer or health plan. You can save pre-tax dollars for qualifying medical and dental expenses, including night guards, with these accounts.
If your insurance doesn't cover the full cost of your night guard, using your HSA or FSA can be a great way to reduce your financial burden. ALIGNERCO takes both as well, so it's convenient to use these accounts to pay for your night guard.
Is Night Guards Insurance Worth It?
The answer to "Does insurance cover night guards?" largely depends on your specific dental insurance plan. Some plans cover 100 percent or part of the cost, while others don't cover night guards at all. It's important to carefully review your plan, get the necessary documentation from your dentist, and explore affordable alternatives like those offered by ALIGNERCO.
Even if your insurance doesn’t cover the full cost of a night guard, ALIGNERCO’s affordable pricing and flexible payment options (including HSA/FSA) make it easier than ever to protect your teeth from bruxism and other issues. After all, a night guard that prevents dental problems from now on could save you thousands of dollars in dental bills later on, so it is an investment.
FAQs
1. Do dental insurance plans cover night guards for bruxism?
Most dental insurance plans will cover night guards for bruxism if your dentist says they are medically required. Coverage varies by plan, and your dentist may need to provide documentation showing the need for a night guard to prevent tooth damage. It’s important to review your policy or contact your insurance provider to confirm coverage details.
2. How much does dental insurance typically cover for a night guard?
The amount of coverage for a night guard on your dental insurance plan will vary, but, generally speaking, most plans will cover between 50 percent and 80 percent, depending on your policy and need for the device. The amount covered can depend on coverage limits, such as an annual maximum, and the type of night guard used (preventive or restorative). Be sure to check for replacement clauses as well.
3. According to the plan, what should I send to my insurance company to get reimbursed for a night guard?
For reimbursement, you'll need a letter of medical necessity from your dentist, diagnostic records that indicate tooth damage, and a detailed receipt. Companies such as ALIGNERCO can furnish the required receipts, making it simpler to file for insurance reimbursement.
4. If my insurance doesn't pay for a night guard, can I pay for it out of my HSA or FSA?
Yes, HSA and FSA funds can be used to pay for a night guard, even if it’s not fully covered by insurance. These plans allow you to cover medical and dental bills (including night guards) with pre-tax dollars. ALIGNERCO accepts HSA/FSA payments, making this a cost-effective option.
5. What are my options if my insurance doesn’t fully cover the cost of a night guard?
If your insurance doesn't cover it all, you can check out more affordable alternatives like ALIGNERCO, which offers custom night guards at a discounted rate. Payment plans as well as utilizing HSA or FSA dollars are also some of the ways to reduce the out-of-pocket expense, making the purchase a little more bearable.
