Does insurance cover dental emergencies?

The biggest question for most people who have medical health insurance is – does insurance cover dental emergencies? The answer to this is, yes, but only if you have a dental insurance policy or you have it’s a rider. Generally, a rider increases the coverage of your insurance policy which in this case is health insurance to include other medical situations for an additional fee. The term “dental emergency” can be quite confusing. You can classify any unfortunate thing resulting from an accident of any kind that affects the normal functioning of your teeth or jaws as a dental emergency.

The position of dental emergencies in health insurance

If you have a health insurance policy that is supposed to cover emergencies, it’s very unlikely that in case of a dental emergency you will be covered. The situation will still be the same even if you are accessing the services from a hospital rather than an independent dental practitioner. This is because most health insurance program regards dental coverage as an option. For this reason, it gets separated from the rest of the policy. This separation means that to get dental coverage from your health poly, you will have to be subjected to different maximums, deductibles, and co-payments. This means that for you to get a health insurance policy, you are going to be spending more money on your insurance policy.

Secondary insurance options for dental emergencies

If you happen to find yourself with a dental emergency, your best bet is a secondary insurance option. Depending on where the accident has happened you will have a number of options you can consider. If the accident occurred at your workplace, you might have the option of being covered by your employer’s liability insurance. Worker’s compensation insurance maybe also an option in this case. On the other hand, if the dental emergency is a result of an automobile accident, the emergency will be covered by the auto insurance medical coverage portion of the motor vehicle insurance.

Medicare and Medicaid

Getting dental emergency coverage from Medicare and Medicaid health plans is an “it depends” matter. According to statistics from the American Dental Association research report from 2013, out of the 50 states, only 42 offered dental services to Medicaid adult enrollees. Out of the 42 states, 16 offered limited dental emergency services. You should note that these dental emergency services in the 16 states were limited to infection and pain relief. Of the remaining 36 states, 15 states offered dental emergency services that extended a little beyond infection and pain relief. Of all the states, only 11offered extensive dental coverage that included dental emergencies. For Medicare beneficiaries, there are no dental benefits of any kind associated with this program. The special case in this program was if you are a beneficiary of Medicare Advantage, you can add dental emergencies as a rider.

TMD Joint and CMD Disorders

If your dental emergency involves the jaws, the jaw joint, or the muscles that control the jaws, then you will be treated under general health insurance. This is notwithstanding whether you have dental insurance or not. This is because almost all states require health insurance to cover this particular type of dental emergencies. Dental emergencies that involve the jaws, the jaw joint, or its muscles can be classified as TMD Joint or CMD disorders.

Despite there being many amendments to the Patient Protection and Affordable Care Act, the dental emergencies have never been addressed. Therefore, unless your insurance pays for it or you have the jaw disorders, all you will get is infection and pain relief.

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