Insurance companies can be notoriously finicky about what is covered under their plan and what isn’t. Generally, when you visit a dentist for a routine cleaning, you can expect your insurance to cover that. So if you were experiencing dental problems due to teeth grinding (bruxism) and your dentist made you a night guard, it seems logical that it would be covered. Yet many people ask “does dental insurance cover night guards?” because the answer is anything but.
This is a tricky question to answer because many people have made the unfortunate discovery that their specific dental insurance does not cover a percentage of the cost of a night guard. Users have been told by their insurance provider that it was due to “preexisting conditions” that caused their teeth to be damaged, creating the need for a night guard months or years later. However, some insurance plans do cover it.
The best way to find out if your specific dental insurance covers night guards is to contact your provider and get things clarified. The fine print of your insurance may mention whether or not “orthodontic” services are covered. As with all fine prints, be aware of the specific terminology that they use, and ask what they mean exactly when you contact your provider.
My dental insurance does not cover the night guard cost, what do I do?!
So you’ve contacted your insurance provider and they told you you aren’t covered. There are still options available to help keep the cost as low as it can be for your specific situation. You may have some tax-advantaged accounts such as the FSA or HSA that you can draw funds from. You may also get a store bought mouth guard or custom night guard from a private dental lab for cheaper than you what you would pay at a dentist’s office.
Tax Advantaged Accounts
Flexible Spending Account (FSA)
If your employer offers this, you may have elected to make contributions to your FSA which is taken from each paycheck automatically until you reach the contribution limit. Your employer may also contribute to it. The maximum total contribution room for the year is $2,650 as of 2019 and you do not pay taxes on this money. Before you or your employer makes an entire year’s contributions towards the FSA, you can access the full amount of your annual election for medical expenses as early as the first day of each year.
In other words, if you use your FSA to pay for a medical expense before you contribute a full year’s amount, your company has to cover that cost for you as if you already made an entire year’s contribution already. Theoretically, you could even leave that job immediately afterwards and you wouldn’t have to finish paying the full amount and the company loses out on that money (and you don’t owe them).
So if it is not the end of the year and you haven’t used all of your FSA funds yet, don’t wait; medical expenses should be dealt with immediately. Don’t be scared to use the funds before the end of the year because the money doesn’t completely roll over year to year. Your employer may offer a 2 ½ month grace period or allow a measly $500 to be rolled over, or neither, and afterwards whatever is left will go back to your employer.
Here is a list of FSA eligible products.
Health Savings Account (HSA)
If you are on a high deductible health plan (HDHP) then you are eligible for a Health Savings Account. Unlike the FSA which your employer owns, you own the HSA and your contributions roll over year after year. Money contributed to the HSA is not taxed, and if spent on qualifying medical expenses such as an orthodontic night guard, is also not taxed.
The money you save by paying with a FSA or HSA is the tax that you would have paid on the medical expenses you will be incurring. If you have either of these accounts, make sure you are contributing to them to save money on taxes. If you are not sure what qualifies as an eligible medical expense, here is a list.
Alternatives to getting a night guard from a dentist
Using those fancy FSA or HSA accounts you just read about, you can purchase a boil and bite mouth guard for teeth grinding or custom night guard.
Store Bought Boil and Bite Mouth Guard
This option is cheaper but not nearly as effective as a custom night guard. However, they work fairly well with many users reporting that it solves their teeth grinding problems. After boiling the mouth guard, you bite into the soft plastic and it will create an imprint of your teeth into the guard.
The mouth guard should fit snug on your teeth so that it stays on throughout the night, and will prevent your teeth from grinding against each other. Some users complain that store bought night guards are too bulky and uncomfortable, or that it can shift your teeth. Read our articles on the benefits of a night guard and dental night guard side effects for more details.
Custom Night Guard
You can skip the middleman (the dentist) and order from a private dental lab directly. When you order a custom night guard online, the lab will send you a plastic mold and instructions on what to do with it. Once you have finished making a mold of your teeth, you ship it back to them with the included prepaid packaging. Finally, they will ship a custom night guard (made using the teeth mold you sent them) that will fit perfectly on your teeth and protect them. Find out how much each type of night guard costs to make an informed decision on which option is the best for you.
So, does dental insurance cover night guards? The answer is it depends on your insurance plan. You should call them to clarify. If they don’t, or they cover only a partial amount, there are other ways to pay so that you can save money. Make sure to use your FSA or HSA account to save on taxes. You don’t have to get a night guard from the dentist, there are cheaper alternatives such as store bought mouth guards or custom night guards from private dental labs. Pay for those with your FSA or HSA account if you can.