Does Dental Insurance Cover Night Guards?

Does Dental Insurance Cover Night Guards?

1st Jan 2020

If you’re here, it’s probably because you suspect you grind your teeth at night, or maybe your dentist has confirmed this for you and told you that you have bruxism. I understand exactly what it feels like to be in this position because I was there, and now I wear a night guard every single night. There are many things to consider when you first realize you have bruxism, and as with any diagnosis it can be scary and overwhelming. The biggest consideration is figuring out where you’re going to get a night guard and even more importantly, how much is the cost of night guards, and does dental insurance cover night guards?

Does dental insurance cover night guards

Wearing a night guard can not only relieve you of the unpleasant side effects of bruxism, such as jaw pain or tooth sensitivity, but it can also help protect your teeth against chipping, cracking, or being worn down over time. Bruxism can also lead to  TMJ disorders, causing pain and even difficulty eating and opening and closing your jaw. Fortunately, night guards help solve these problems, keeping your mouth and jaw pain free and functional.

Unfortunately, night guards can be pricey, especially if they’re not covered by your dental insurance policy. Continue reading to learn how to find out if your dental insurance covers night guards, what to do if they aren’t, and what is your dental insurance policy for night guards.

Does Dental Insurance Cover Night Guards?

When your dentist first informs you that you need a night guard, the dental office might advise you on whether your insurance company will cover the cost or not. While your dental office has experience in this area, all dental plans are different, so you’ll want to check in with your insurance company to confirm coverage. If your dental office tells you night guards are covered but you find out later they aren’t, you’ll still be responsible for covering the cost of night guards.

Dental Insurance

To be sure, check in with your insurance company. In most cases, you can review your plan online, or you can call your dental insurance customer service and ask for a representative to explain your benefits. He or she will be able to tell you whether night guards are fully covered, partially covered, or not covered at all.

Most dental insurance plans cover preventative care such as cleanings and x-rays, but not all plans cover major care such as crowns and night guards. If your plan covers other major care such as crowns, bridges, or dentures, it likely covers night guards, but always be on the safe side and check first.

Once you find out if your plan covers night guards, you’ll also need to check on how much they are covered. Often, night guards are covered at 50%, which means you would be responsible for paying half the price of the night guard (or of your plan’s allowance for night guards, whichever is cheaper) while your insurance company pays the other half. If your dental provider (aka your dentist) is out of network, you could end up paying more than half even if your plan covers night guards at 50%.

Sound like a bunch of jibberish? We get it--insurance is confusing. Let’s look at a couple examples. For both scenarios, we’ll pretend the total cost of the night guard without insurance is $1,000 and that your insurance plan’s allowance (the amount they’ll allow your dentist to charge) for night guards is $800.

Cost of night guards

Scenario 1: Your dental provider (aka your dentist) is in network (meaning they participate with your insurance plan) and your insurance covers night guards at 50%. This doesn’t necessarily mean you would pay half of the price for your night guard, because the allowance plays a role as well. With a participating provider, you’ll pay half of the allowance, not necessarily half of the cost of the night guard. So in this case, you would pay $400.

Scenario 2: Your dental provider (aka your dentist) is out of network (meaning they don’t participate with your insurance plan) and your insurance covers night guards at 50%. In this case, you would still pay half of the allowance, which would be $400, but you would also need to pay the difference between the total cost of the night guard and the allowance, which is $200. In this scenario, you would pay $600 out of pocket total for your night guard.

Amount of coverage, allowances, and dollar limits on dental insurance plans all depend on your particular dental insurance provider and your specific plan, so it’s always best to check with your dental insurance provider on what’s covered and how much is covered by insurance in your situation. The bottom line is you can end up spending a lot of money on a night guard if you buy it through your dentist, whether it is covered by your insurance or not.

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Your Options When Night Guard is not Covered by Your Insurance

Finding out your insurance doesn’t cover night guards is a major bummer. Your teeth are literally aching for relief, but the number that your dentist quoted you to pay for a night guard out of pocket is astronomical. If this is your situation, you have two major options that won’t cost you an arm and a leg: over-the-counter mouth guards and custom-fit night guards.

Custom-fit night guards

Over-the-counter Mouth Guards

This first option is probably very tempting because you can walk into your local drugstore or pop on Amazon and quickly have a night guard for a fraction of the price your dentist quoted. Unfortunately, while cheap and convenient, this option is not ideal.

Over-the-counter night guards claim to be one size fits all, but that just doesn't hold true in reality. Some over-the-counter night guards use the “boil and bite” technique to attempt to mold the guard to your mouth, but you’re just not going to get that perfect fit that you’ll get with a custom night guard.

If you’ve ever had to use a boil and bite mouth guard for a sport, you’ll remember how they tend to move around or fall out because it’s just impossible to get that perfect fit with a product that is designed to accommodate every mouth.

Additionally, over-the-counter night guards are more likely to lead to negative side effects such as pain, tooth shifting, or jaw misalignment. These are likely the exact problems you’re trying to fix by getting a night guard. Fortunately, you can order custom-fit night guards online; they’re a better option than over-the-counter night guards, and they’re still affordable!

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Custom-fit Night Guards

Rather than being one size fits all, custom-fit night guards online allow you to take impressions of your teeth just like your dentist would do in the office. By ordering them online, you cut out the middle man, so it’s much cheaper than it would be if you went through your dentist, and you get to do it all from the comfort of your own home.

The process is simple:  order your impression kit, follow the instructions to take your impressions at home, mail your impressions in the prepaid envelope, and then wait for your custom night guard to arrive at your doorstep. Pro Teeth Guard also makes adjustments free of charge until your night guard fits your mouth perfectly, so you’re much less likely to experience the negative side effects you might experience if you were to go with an over-the-counter night guard.

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The Bottom Line

Night guards aren’t cheap, but neither is restorative dental work. Fixing chipped or fractured teeth is expensive, and it’s also not very fun. If you want to protect your smile and you’re tired of the negative side effects of clenching and grinding your teeth at night, it’s imperative you get a quality night guard that fits your mouth and protects your teeth.

Especially when insurance doesn’t cover night guards, you want to weigh your options with the goal of getting a quality night guard at a price you can afford. Don’t take a chance on an over-the-counter night guard that might or might not fit your teeth. Opt for a custom night guard that will feel comfortable and is guaranteed to fit.