You might be a little rough with your brush or forget to floss every now and then. You may have just been unfortunate genetically. You may wonder how much it will cost when your dentist looks into your mouth to suggest that you need gum surgery in order to cover the sensitive area where your gums are receding. This article examines the dental insurance coverage of gum grafting and explores various factors that may affect your coverage.
What is gum recession?
A condition called gum recession occurs when the gum tissue surrounding the teeth recedes and exposes more of the root or tooth. This condition is caused by a number of factors including periodontal diseases, aggressive tooth-brushing, traumatism, crooked or twisted teeth, genetics and vitamin deficiencies. Other causes include tobacco use, poor hygiene, hormonal changes, genetics and crooked or twisted teeth. Untreated gum disease is linked to serious conditions such as diabetes, heart disease and other inflammatory diseases.
Gum transplantation is used to correct recession by transferring a small piece of tissue. The graft is usually taken from the roof and placed over the exposed roots to prevent further recession. It also reduces sensitivity. The graft will protect your teeth from decay and enhance the aesthetics of the smile once it is placed.
Do insurance policies cover gum grafts?
It’s important to understand what kind of insurance coverage you have before you can find out if it covers gum grafting. According to a recent National Association of Dental Plans research (NADP), 88% of Americans have dental insurance. This can be a privately funded plan or a public-funded one.
Dental care is not covered by public insurance plans such as Medicare or Medicaid. If you have a Medicare Part C plan, however, dental care will be covered. This will vary depending on the plan. You will have to check with your policy. Some Medicare Advantage plans may cover gum grafting.
Commercial Dental Insurance Plans are offered by employers and purchased on the market. They include Preferred Provider Organizations, Health Maintenance Organizations and indemnity plans. Delta Dental is a major player in the commercial dental industry. Other big players include Cigna and Anthem BlueCross BlueShield. Humana Dental Renaissance Dental MetLife Dental United Healthcare are also important players. Commercial dental plans offer varying levels of coverage, making it difficult to determine if gum surgery is covered by dental insurance and how much gum grafting will cost.
- Dental PPO. The most popular type of commercial dental insurance, accounting for 86%. Patients can pay less when they choose a dentist from a network and pay a co-pay percentage agreed upon for basic and major restorative treatments. The insurance company and provider agree on the procedure fees.
- A dental HMO. A plan that aims to reduce costs. Patients are assigned or choose a primary care provider in a smaller network of providers and require a referral before they can see a specialist. Preventive care is the focus, with out-of network costs not being covered. Prior to major dental procedures, pre-authorization may be required.
- Indemnity. This is the most flexible plan, and it usually has no provider network. The plan pays a certain percentage of the service fees, up to a specified maximum.
There are three levels of coverage
You can choose between two levels of coverage in most commercial plans. The basic dental plan covers preventive services such as cleanings and exams. Some plans will cover some basic restorative procedures (fillings, extractions), but not major ones like gum grafting.
The middle and upper tiers of more comprehensive plans will often be based on the plan, which provides 100% coverage for preventive care; 70-80% for basic restorative treatments; and 50% for major services. This includes gum graft surgeries. The remaining balance is paid by the patient.
Plan details can differ greatly. It is important to review your dental insurance plan for specific coverage information.
Factors affecting coverage for gum grafting
The extent of dental insurance coverage for gum grafting can be affected by several factors, including the plan type and coverage level.
Cosmetic procedures vs. medical necessity
Insurance coverage can be determined by whether the procedure is medically necessary or purely cosmetic. Insurance policies cover medically-necessary procedures that restore or prevent a condition from worsening. Most often, gum grafting will be covered if it is done to treat periodontal diseases or prevent tooth loss.
Limits of coverage and deductibles
The annual plan limits, deductibles and insurance policies can all influence the coverage for gum grafting. Most insurance plans have a maximum payout that can range between $750 and $2,500 per year. A yearly deductible is usually required, ranging between $0 and $75 in procedure fees. Co-payments are also necessary.
Conditions pre-existing and waiting periods
Waiting periods and pre-existing conditions can complicate insurance coverage. Some insurers may not cover treatment if gum recession was detected before insurance coverage. The waiting period can range from a few weeks to more than a year before major procedures will be covered.
What coverage do you have?
No one wants to be surprised by a large bill for a medical visit. You should always check ahead to see if your health insurance covers your service so that you can plan accordingly. Consider these steps to verify that your gum grafting will be covered:
- Examine your insurance policy. Examine your insurance policy carefully to ensure you understand the coverage, including any limitations or exclusions.
- Consult your dentist. Ask your dentist whether the gum graft procedure is medically required.
- Pretreatment estimate. Request a pretreatment estimate from your insurance provider by having your dentist provide a detailed treatment plan.
Alternatives to gum Grafting
There are other options to a surgical gum transplant if your gum recession has been mild. These alternatives may be sufficient to stop the progression. Other alternatives include better oral hygiene, root planning and scaling, and laser gum treatments. Consult your dentist to determine the best treatment for you.
Grafting is the only solution if you have significant gum loss. In the United States, there is a persistent concern about the high costs of dental care. This includes preventive treatment and restorative treatments. It’s best to prevent gum diseases from occurring.
Take charge of your dental health
Prevention of gum disease requires proactive dental care. Maintaining good oral hygiene, including brushing and flossing properly, can reduce the risk for developing severe gum problems. Other home remedies that can help prevent and manage gum disease include oral bacterial probiotics and water flossers.
Insurance coverage for gum grafting depends on a number of factors. These include the need for the procedure, the degree of gum recession and the details of the dental plan. You can better understand your coverage options by reviewing your insurance plan and consulting dental professionals. The best way to avoid the need for major interventions such as gum grafting is to practice proactive oral hygiene.
The FAQ
What is the difference between gingivitis and gum recession?
The gums can become infected, leading to inflammation and bone loss. Gum recession occurs when the gum tissue pulls away from the teeth exposing the root or more of the tooth.
What is the most popular type of dental coverage?
Preferred Provider Organizations (PPO) are the most common form of dental insurance. PPOs provide a network dentists that offer services at discounted rates to members of the plan. This allows for greater flexibility when choosing dentists.
How often will dental insurance cover the entire cost of gum grafts?
Most dental insurance plans do not cover the entire cost of gum surgery. The majority of plans cover a portion of the cost, usually if the procedure is medically required. Patients may be responsible for some of the costs, including co-pays and deductibles.
Takeaways:
- Commercial dental plans that are more comprehensive will likely cover some of the cost of gum grafting. These comprehensive plans include coverage for major dental procedures.
- Dental insurance will cover gum grafting if it’s deemed medically necessary and not cosmetic. The severity of the gum recession may also affect whether or not insurance covers gum grafting.
- You should review the details of your dental insurance plan or contact your provider directly to find out if gum grafting will be covered.
- Before recommending gum grafting, those with mild gum recession may be advised to improve their dental hygiene or undergo scaling and root planing, laser gum treatment, or other alternatives. These treatments can help manage and slow down the progression of gum receding.
- In order to prevent conditions that may require gum grafting, it is important to maintain good oral hygiene and have regular dental examinations. Active management is essential to oral health and can prevent the need for invasive procedures.
