Does dental insurance cover crowns?

Are crowns covered by dental insurance? The short answer is yes, but not in all cases. The most important determinant is the reason for the procedure. If done for health reasons, coverage is possible. If done only for cosmetic reasons, chances are the crown is not covered.

What Does Dental Insurance Typically Cover?

The typical annual maximum coverage cap on dental insurance amounts to a median of $1,500. It covers procedures strictly related to health and wellness, and it has a three-tier structure known as 100-80-50.

Preventive care—such as annual cleanings, X-rays, and sealants—is covered 100%. Basic procedures—such as fillings, extractions, and periodontal treatment for gum disease—are covered 80%. Major procedures—crowns, bridges, inlays, and dentures—are covered 50%. Depending on your plan, root canals can fall into either the basic or major category. Most plans focus on preventive and basic care, and not all procedures are covered.

Most insurance companies have a waiting period for new patients, though there are some that don’t. This waiting period usually applies to nonemergency procedures, such as crowns, and typically ranges anywhere from a few to 12 months, though it can be as long as two years for some companies.

Annual coverage limits, which can be as low as $1,000 despite the median mentioned above, can result in a situation where a lost filling or cavity earlier in the year has already eaten up a large portion of that year’s dental allowance. This would likely result in a crown being covered at less than 50%, so you have to be strategic about when you plan for certain procedures.

How Much Does a Dental Crown Cost With Insurance?

Most dental plans cover the cost of dental crowns in cases where a patient has a weak or cracked tooth. However, crowns are generally not covered if they’re requested purely for cosmetic reasons. That’s because dental insurance usually doesn’t cover cosmetic procedures, which exist for the main purpose of improving the appearance of a patient’s teeth and smile rather than for health reasons. Other cosmetic procedures include whitening treatments, veneers, bonding, and straightening procedures, such as Invisalign. The patient has to pay the entire cost of these treatments.

Although the cost of crowns depends on whether the material used is porcelain or metal, the price tag can range from $807 to $2,015 per crown. And remember, the cost is generally only covered at 50%. The patient must pay the remainder. Dentists can provide preliminary estimates and many offer payment plans. Furthermore, credit plans such as CareCredit offer low-interest financing methods, and some dental schools offer low-cost dental procedures. Employer-sponsored plans generally require lower insurance premiums due to group coverage.