Does Insurance Cover a Chipped Tooth?

Dental insurance helps pay for variety of preventive, basic, emergency and catastrophic dental procedures. Knowing that major dental problems won't also become monetary catastrophes can provide peace of mind. Dental insurance providers and policies differ as to the procedures they cover, how much they pay and under what circumstances. Reviewing your policy rules closely can help you determine if you'll get help in paying for that chipped tooth.

Dental plans typically cover basic procedures. Repairs -- including bonding, the use of a tooth-colored plastic resin -- to a tooth that has been accidentally chipped or cracked is generally considered a basic procedure. Bonding or other repairs for cosmetic reasons typically are covered only if necessary to maintain the tooth's structure.

Even if your tooth repair falls under the category of a basic procedure, your insurer probably won't pay all of the cost. Most dental plans have a co-pay, usually $10 to $25, that you must pay at the time of service. Your plan also may require that you visit a dentist in its provider network. Veer outside the network and it won't pay anything toward your chipped tooth.

Like car insurance policies, many dental policies also have deductibles. A deductible is the dollar amount you must pay in a year before insurance pays anything. Insurance policies also have maximum annual limits. If you've exceeded yours, the plan won't cover your chipped tooth. Insurance policies often exclude pre-existing conditions, so if your tooth was chipped before you bought the dental insurance, you may be stuck with paying for all of it yourself.

You may consider asking your dentist to prepare an estimate before he begins work on your tooth. This will tell you exactly what is covered by insurance and what isn't so you can be prepared financially. If your policy won't pay, you may be able to negotiate payment arrangements with your dentist.