Does medical insurance cover mouth guards?

Does medical insurance cover mouth guards?
Image: Does medical insurance cover mouth guards?

Yes, medical insurance may cover mouth guards in certain cases. Generally, coverage is only provided when they are prescribed by a healthcare provider to treat a specific medical condition, such as a misalignment of the teeth or TMJ disorder. If your doctor has recommended that you use a mouth guard and it is considered medically necessary to protect your oral health, then you can often get some level of reimbursement from most major insurance providers.

Types of Mouth Guards

Types of Mouth Guards
Image: Types of Mouth Guards

Mouth guards, also known as mouth protectors, come in a variety of shapes and sizes. Depending on the activity they are being used for, people may need to invest in different types. Here is an overview of the four most common types available:

The stock mouth guard is preformed and ready to wear right out of the package. It’s typically made from polyethylene or ethylene vinyl acetate (EVA) and comes at an affordable price point. However, this type offers less protection than others due to its bulky fit and poor comfort level – making it unsuitable for vigorous activity.

For higher impact activities such as contact sports, a boil-and-bite mouth guard is recommended. This type needs to be softened up in hot water before fitting over teeth, but once done provides more protection thanks to its snugger fit that won’t slip during physical play. It can still be uncomfortable though and some users have been known to struggle with getting it just right so that it completely covers their upper row of teeth while maintaining breathability at the same time.

Custom-made mouth guards provide unparalleled protection because they’re tailored precisely according to individual specifications provided by a dentist or orthodontist – giving them superior coverage when compared against store-bought products. Of course, since each one requires special attention from professionals these tend to carry the steepest price tag too; hence why this option isn’t suitable for all budgets.

Finally there’s the night guard which has been designed specifically for sleep bruxism – otherwise known as grinding teeth during slumber – though some athletes have also adopted them for added cushioning on top of their primary mouth protector during games or practice sessions. While it does provide extra support between dental surfaces throughout restful hours.

Benefits of Wearing a Mouth Guard

Benefits of Wearing a Mouth Guard
Image: Benefits of Wearing a Mouth Guard

Mouth guards provide a number of beneficial protective benefits for people participating in physical activities. Although originally designed with contact sports in mind, mouth guards are widely used by anyone engaged in activities such as basketball, soccer, baseball, field hockey and even extreme sports like snowboarding and skateboarding. Mouth guards protect teeth against damage from clenching or grinding and absorb shock from blows to the face.

Moreover, wearing a mouth guard reduces the risk of concussion by cushioning the head from impact forces. A quality-constructed guard can help support proper jaw alignment and also help prevent soft tissue injuries that occur to lips and tongues due to trauma. Athletes may use them as an aid for improved performance, since they reduce fatigue associated with clenching during sport activity or an increase in breathing capacity through better air flow when worn during practice or play.

Those suffering from bruxism (the habitual grinding or clenching of teeth) should always wear a custom fitted mouth guard at night to prevent tooth movement and potential deterioration of their oral health over time. Medical insurance plans typically do not cover mouth guards unless medically necessary however the value associated with protecting your smile is priceless.

Oral Injuries Commonly Treated With Mouth Guards

Oral Injuries Commonly Treated With Mouth Guards
Image: Oral Injuries Commonly Treated With Mouth Guards

Mouth guards are a protective tool used to protect the teeth, gums and jaw from physical trauma during contact sports. Those who participate in contact sports such as hockey, lacrosse and boxing may be at risk of sustaining serious oral injuries due to collisions with other players or equipment. While mouth guards cannot prevent all injuries, they can help reduce their severity by cushioning impact that would otherwise cause broken teeth or jaw fractures.

Common oral traumas treated with mouth guards include broken teeth and avulsed teeth (teeth being knocked out). In either case, a properly fitted mouth guard can reduce the force of impact and minimize the associated pain and damage. For example, if an athlete is struck in the face but wears a well-made mouth guard while playing, they are more likely to retain their original tooth structure than if no protection was worn at all.

Aside from protecting against severe injury, wearing a custom-fit mouth guard can also provide stability for dental work such as braces or bridges. This will decrease the chance of brackets becoming displaced or broken wires injuring soft tissue within the cheeks or lips. Mouth guards create a barrier between these delicate appliances and external forces which could otherwise disrupt them – preserving optimal results throughout treatment.

How Does Insurance Cover Mouth Guards?

How Does Insurance Cover Mouth Guards?
Image: How Does Insurance Cover Mouth Guards?

Many people are unaware of how exactly insurance plans cover the purchase of mouth guards. This is because, traditionally speaking, health insurance does not pay for “cosmetic” treatment – this includes prevention. However, dental insurance will often cover a portion or all costs for mouth guard purchases if your doctor has prescribed it to treat one of these problems: bruxism (teeth grinding), sleep apnea, or TMJ disorder.

In order to receive coverage through your medical insurance policy, you must have a medical need that requires wearing a mouthguard in order to alleviate the symptoms associated with it. Your dentist will be able to determine whether you fit into this category and qualify for reimbursement from your provider. In some cases, even if your insurer does not fully cover the cost, they may provide partial coverage depending on the type of service and deductible levels on your plan.

Dental insurers usually classify mouthguards as preventive services but there may also be some basic coverage provided under major medical plans that can assist with paying out-of-pocket expenses related to a prescribed nightguard or sports guard. It is important to contact both your health and dental providers before purchasing any products in order to understand what type of coverage you could expect for the specific product being purchased and to avoid unwanted surprises later on down the road.

Determining the Cost of a Custom-Made Mouth Guard

Determining the Cost of a Custom-Made Mouth Guard
Image: Determining the Cost of a Custom-Made Mouth Guard

The cost of a custom-made mouth guard is typically more expensive than over the counter versions. Generally, these guards are created by dentists and orthodontists, who charge fees for molding, fitting, and fabricating each piece to fit comfortably in your patient’s mouth. In most cases, these costs range anywhere between $200 to $400 depending on the complexity and materials used.

For those seeking more protection or relief from discomfort during activities such as playing contact sports, investing in a higher-end model may be warranted. These specialty guards can cost upwards of $500 due to their specialized design process which includes obtaining impressions from dental professionals at various stages of treatment. Some high-end models may come with additional features such as molded plastic shields for added protection that can add an extra few hundred dollars onto the price tag.

When it comes time to pay for a custom-made guard, there are several factors that you should consider before making your purchase. Many insurance providers offer coverage of up to 80% when the guard is medically necessary. Be sure to check with your provider beforehand if they cover any part of the cost so you know what amount will be expected out of pocket prior to committing to make your purchase.

Alternatives to Traditional Medical Insurance Coverage for Mouth Guards

Alternatives to Traditional Medical Insurance Coverage for Mouth Guards
Image: Alternatives to Traditional Medical Insurance Coverage for Mouth Guards

One of the most effective ways to shield your teeth from harm is by wearing a mouthguard. Unfortunately, traditional medical insurance plans may not always cover the cost of such protection. Fortunately, there are some alternatives to relying solely on insurance to secure mouth guards for you and your loved ones.

Those who do not have access to dental insurance or have experienced changes in their healthcare coverage can look into finding an independent dentist. These dental professionals often provide services that are covered by flexible spending accounts (FSAs) which allow individuals to pre-pay out-of-pocket medical costs with tax-free dollars. Many FSA programs also offer discounts for custom fitted mouthguards and other tooth protectors like night guards or bite splints.

For those looking for something more affordable than custom mouthguards, over-the-counter versions can be purchased at drugstores, sporting goods retailers and online merchants. While these products generally won’t provide as much protection as custom fitting options, they still work effectively in many situations and carry significantly lower price tags – usually no more than $20 – $30 depending on quality level chosen. All over-the counter models should meet safety standards set by The American Dental Association so even budget shoppers can feel safe using them on their teeth.

  • James Berkeley

    ตั้งอยู่ในกรุงเทพฯ, James ทำให้การประกันภัยเรียบง่ายด้วยการสัมผัสที่เป็นส่วนตัว ภูมิใจที่เป็นศิษย์เก่าของ University of Edinburgh Business School พร้อมด้วย MSc in Law.


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