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Why does dental insurance not cover antibiotics?

Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted...

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella...

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UPDATED: Mar 19, 2020

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Sometimes, through the course of dental treatment, antibiotics are needed which raises the question, why does dental insurance not cover antibiotics? Antibiotics are prescription drugs that are generally covered by medical insurance or a prescription drug plan.

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However, dental insurance will not cover antibiotics, even when they are needed due to dental work, because the infection in need of antibiotics is a medical issue, not a dental issue.

The same is true, for example, if a cavity is causing you pain. The cavity is a dental issue so health insurance will not cover the filling of the cavity. The following article will provide additional information about this topic.

Why would I need antibiotics for dental work?

Dental work can be considered anything from a routine cleaning to a full blown root canal to oral surgery. Your mouth is full of soft tissue and, as with any soft tissue, there is risk of infection if the soft tissue is damaged. This damage can be the result of something you have done, such as cutting your gum with dental floss or something that is a result of a visit to the dentist.

For example, a root canal requires extensive cutting inside the mouth as does other types of dental surgeries. When this happens, the soft tissue is exposed to germs and there is a risk of infection. The risk increases when food is put into the equation.

Some dentists will only recommend antibiotics if an infection begins; other dentists will recommend antibiotics as a precautionary measure when any oral surgery or dental work will be done. If the antibiotics are only a precautionary measure, it is up to you whether or not to have the prescription filled.

An untreated infection in the mouth can quickly spread to other parts of the body and require hospitalization or result in additional dental problems that need treatment. Antibiotics are a regular practice of many dentists and dental offices.

If you have medical health insurance with a prescription drug benefit, antibiotics for dental treatment are typically covered. Your prescription drug benefit doesn’t require you to specify what the antibiotics are for and why they are needed.

There are other options:

  • Many large pharmacies and grocery stores even offer free basic antibiotics to customers.
  • Some large store chains will offer all basic antibiotics for a low flat fee.

There are many ways to find affordable antibiotics that have been prescribed because of dental care or any other reason, once the prescription has been given.

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What does dental insurance cover?

If dental insurance does not cover antibiotics, you may be wondering what exactly dental insurance does cover. Well, it depends on the type of plan that you have and what coverage that plan offers. Typical dental insurance plans cover two yearly cleanings for all family members on the plan. They will also cover preventative treatments for children ages 6-12. This includes such things sealants or spacers. The insurance company knows that preventing future dental problems will save them money over the lifetime of the dental insurance policy.

Dental insurance typically partially covers things like:

  • Fillings
  • Repair of chipped teeth
  • Deep cleanings
  • Gum disease treatment

Usually a dental insurance policy will have a co-insurance and a co-pay. Co-insurance is a percentage of the overall treatment cost that is covered by you out of pocket. This can be an 80/20 plan or a 70/30 plan. When you pay your part of the bill, the insurance company will pay their part. Having co-insurance is not as good as full coverage, but it will still have you money, especially if you have a family with multiple children.

A co-pay is the amount you need to pay towards each visit. This is how much you will pay each time you have an appointment regardless of what the appointment is for. The co-pay will be the same for a cleaning or a root canal. Co-pays are:

  • In addition to co-insurance
  • Paid out of pocket

All of the information about co-insurance and co-pays should be readily understood before signing the policy so you are not surprised about costs when a dental need arises.

To find an affordable dental insurance policy, try using an online comparison tool. This type of tool will allow you to see what different dental insurance companies and policies have to offer. The online comparison tool will show you rates and quotes so you can compare and save.

Start using the online dental insurance quotes tool today by entering your zip code now!

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