Porcelain veneers can give you the beautiful, bright smile you’ve always wanted. But these thin ceramic shells designed to cover the front of teeth don’t come cheap, often costing $900 to $2,500 per tooth.
This leads many to wonder Will my dental insurance cover porcelain veneers? Or will I be stuck paying thousands of dollars out of pocket?
Unfortunately, most dental insurance plans classify veneers as a cosmetic procedure and do not provide coverage. However, exceptions exist, and you may be able to get partial insurance coverage in certain situations.
This comprehensive guide explains everything you need to know about porcelain veneers insurance coverage, from what plans may pay to tips for keeping costs down.
What are Porcelain Veneers?
Before diving into insurance, let’s look at exactly what porcelain veneers are and why people get them.
Porcelain veneers are thin shells, around .5 – .7 mm thick, made of ceramic material that are bonded to the front surface of teeth. They are a great way to:
- Whiten and brighten teeth
- Mask chips or cracks
- Fix minor spacing or crowding issues
- Cover broken, misshapen or abnormally small teeth
- Generally, improve the aesthetics of your smile
The veneers adhere to the underlying tooth with dental bonding cement. They are considered a minimally invasive form of cosmetic dentistry since very little enamel has to be removed for them to be placed.
The entire process of getting porcelain veneers takes about 2-3 visits to the dentist. Veneers can last 10-15 years with proper oral care before needing replacement.
READ ALSO: Tips and Tricks: Making Dental Implants Affordable With Insurance
Why are Veneers Usually Not Covered by Insurance?
Most standard dental insurance plans differentiate between services that are medically necessary and elective cosmetic treatments. Porcelain veneers almost always fall into the cosmetic category.
Insurers consider procedures medically necessary if they treat or prevent dental disease, repair damage from injury or decay, or restore function. Cosmetic treatments mainly improve aesthetics.
Some key reasons veneers are typically deemed cosmetic include:
- They do not treat underlying oral health issues.
- The tooth structure is intact, other than aesthetic defects.
- Alternatives like orthodontics or whitening exist to improve appearance.
- Veneers are optional, not urgent or essential.
- Patient motivation is primarily improved smile aesthetics.
Since veneers are elective, insurers classify them as an excluded procedure not covered under basic dental benefits.
When Will Dental Insurance Cover Porcelain Veneers?
While rare, there are some situations where your dental insurance may pay for a portion of your veneers if they are justified as a medically necessary treatment.
Potential scenarios where you can get coverage include:
- Repairing damage – Fixing chipped, fractured, or broken teeth that cannot be restored with fillings or crowns.
- Tooth defects – Congenitally missing, malformed, or abnormally small teeth causing functional issues.
- Root canal treated teeth – Restoring appearance of discolored teeth after root canal treatment.
- Accidental injury – Trauma, injury, or accident resulting in damaged front teeth.
- Weakened tooth structure – Thin or translucent teeth prone to fracture are reinforced.
- Excessive wear – Worn, eroded teeth from acid reflux or tooth grinding are restored.
The key is for your dentist to clearly document the medical or dental necessity for veneers, usually with photos, x-rays, and charts showing defects or damage.
Submit your dental insurance claim with details on why veneers are not solely aesthetic but rather a restorative treatment for tooth issues that impair form and function.
What Insurance Plans May Cover Porcelain Veneers?
Coverage for veneers can vary significantly between different types of dental insurance plans.
- Dental HMOs – Least likely to cover veneers. Limited to only medically essential care.
- Dental PPOs – May provide partial coverage for veneers for medical reasons with proper documentation. More flexibility than dental HMOs.
- Vision/Dental Combo Plans – Usually exclude orthodontics and cosmetic services like veneers.
- Discount Dental Plans – Provide set discounted fees from participating dentists, but no direct coverage. May offer discounts on veneers through network dentists.
- Pediatric Dental Plans – Cover children’s basic/preventive dental care, but not elective veneers.
- Orthodontic Insurance – Covers braces for kids and adults, but not veneers.
- Cosmetic Dentistry Riders – Additional coverage is specifically for elective cosmetic services like veneers. Offered by some dental insurers.
Talk to your dentist and insurance company to get clarity on your unique policy coverage and exclusions for porcelain veneers.
Out-of-Pocket Costs with Insurance Coverage
Even if approved by insurance, you’ll still have out-of-pocket costs for your porcelain veneers. These often include:
- Deductible – Annual amount you pay before coverage kicks in, usually $50-$100.
- Coinsurance – Percentage of the bill you pay after the deductible, commonly 10%-50%.
- Annual maximums – Plans limit yearly benefits, often $500-$1,500.
So for a $5,000 veneer procedure, if your plan has a $75 deductible, 20% coinsurance, and a $1,000 annual maximum, you would pay:
- Deductible = $75
- 20% coinsurance = $1,000
- Remainder due to hitting annual maximum = $3,925
- Total out-of-pocket cost = $5,000
While not ideal, any amount covered by insurance will help reduce your overall costs for porcelain veneers. Just be sure to get a pre-treatment estimate of benefits from your insurer.
Filing Claims and Appeals for Veneers
Here are some tips to handle the insurance claim process for your veneers:
- Have your dentist clearly state your condition and need for veneers on the claim submission.
- Provide compelling evidence of medical necessity, like photographs, x-rays, or dental records.
- Get a predetermination from the insurer before treatment to verify coverage.
- Thoroughly review reasons if your claim gets denied.
- File an appeal if denial seems improper based on your policy and dental condition.
- Utilize “peer to peer” reviews between your dentist and dental directors when appealing.
- Consider assistance from dental advocates to appeal improper denials.
With persistence and all the right documentation, you can overcome initial claim denials and get the veneer coverage you may be entitled to.
Other Ways to Reduce Veneer Costs
If you can’t get coverage, there are other ways to lower the cost of your porcelain veneers:
- Choose resin composites instead of porcelain. Composite veneers can cost 40% less.
- Select a quality dentist that offers competitive pricing without sacrificing quality. Get multiple estimates.
- Ask your dentist if they offer any discounts or in-house savings plans for veneers.
- Apply for third-party financing like dental loans or credit cards with low promotional interest rates.
- Take advantage of dental tourism for significant savings on veneers done in certain countries. Factor in travel costs.
- Opt for veneers only on the most visible upper teeth instead of your whole smile.
- Consider dental schools where supervised students may offer veneers at discounted rates.
- Book your veneer procedure at a time of year when you will maximize other insurance benefits to help offset costs.
With some savvy planning, shopping around, and utilizing the insurance coverage you have, you can reduce the costs of porcelain veneers to a more manageable range for your budget.
To Recap: Veneers Are Rarely Covered, But Exceptions Exist
While porcelain veneers may seem like an unattainable luxury for your budget, there are ways to potentially get insurance coverage or reduce costs through other means.
With careful planning and persistence, you can get the smile of your dreams. Just be sure to have realistic expectations of what insurance will pay, thoroughly understand your policy’s exclusions, and be prepared to pay at least some of the veneer costs out-of-pocket.
Many find this investment worth the long-term payoff of permanently upgrading their smile’s appearance with porcelain veneers. Evaluate the options and partner with an insurance-savvy dentist to develop the most strategic plan.
Veneers Insurance Coverage FAQ
Below are answers to some frequently asked questions about dental insurance and porcelain veneers:
Do dental HMOs ever cover veneers?
Rarely. HMOs emphasize only basic care and preventative services. Veneers are seen as cosmetic and are not covered unless a very strong medical need is proven.
Can I get veneers covered after an accident?
Yes, veneers to repair fractured or damaged teeth due to a dental injury may be covered since accident-related treatments are usually covered. Proper documentation will be key.
Does my employer dental plan cover veneers?
It depends. Some employer-sponsored group dental plans do include limited veneer coverage when medically necessary. Others exclude them as cosmetic. Check your specific plan details.
What documentation is needed for veneer insurance coverage?
You’ll need dental records, charting notes, x-rays, photographs, and a letter from your dentist stating the medical reasons veneers are needed to fix your particular tooth condition or damage.
Is approval guaranteed if veneers are medically necessary?
Not necessarily. Insurers still have some discretion and may deny claims even with proof of necessity. Be prepared to submit appeals if this happens.
Can I get adult braces and veneers approved together?
Unlikely. It is very difficult to get insurance to cover comprehensive cosmetic treatment plans. You’d need to separately prove braces are medically required and veneers fix specific dental defects.
Will Insurance Cover Replacing My Veneers?
While getting initial veneers covered is difficult, replacing old veneers is often easier to get approved for.
Reasons replacement veneers may get insurance coverage include:
- The underlying tooth is unstable and functionally impaired without the veneer.
- Not replacing the veneer could result in fracture or tooth loss.
- Replacement is the only way to address damage, decay, or significant wear.
- The original veneer lasted 10+ years, a reasonable lifespan.
Because the enamel is removed for the initial veneer, most insurers consider a replacement veneer medically necessary to maintain tooth integrity. Proper documentation of the tooth’s cracked, worn, or damaged veneer showing the need for replacement can get coverage.
Should I Notify My Insurance If Paying Out-of-Pocket?
If you don’t expect to get coverage, it can still be wise to give your dental insurer notice before getting veneers. This allows them to:
- Document it is an elective procedure not done for a later dental problem.
- Update your records in case veneer replacement is needed years later.
- Advise if policy changes later allow for any coverage.
Merely having your dentist submit a letter briefly explaining your planned elective veneers for aesthetic reasons provides sufficient notice.
In another related article, Can Invisalign Be Covered by Dental Insurance? What You Need to Know
