How much do veneers cost per tooth with insurance?
Every person will get a different answer because three critical variables enter the equation.
First, you have to get your insurance to cover veneers. Demonstrating a medically necessary reason is crucial unless you have a plan that includes cosmetic procedures.
Second, most dental plans include an annual maximum benefit, so the number of teeth you restore in a year affects the claims support you might receive.
Finally, the material used to fabricate your veneers has widely different price points and could affect whether insurance pays at all.
When does Insurance Cover Veneers?
The procedure’s reason and type of plan in question determine when insurance covers dental veneers. There is no single correct response. The people who get their veneers covered by insurance have a medically necessary reason, or their plan includes cosmetic dentistry.
You might need to find alternatives.
Medicaid
Medicaid may cover veneers depending on the rules in the state where you live. Each state determines what benefits to offer, and two sets of medically necessary rules could apply.
- In thirty-three states, Medicaid covers restorative oral care for adults, which works like dental insurance in these regions.
- Medicaid works like health insurance nationwide, meaning treatment must extend to other parts of your body.
For example, Medicaid might pay for veneers for patients with Celiac Disease across the country, but only in thirty-three states after a biting accident.
Dental Insurance
Your dental insurance is more likely to cover veneers because these plans focus on oral health issues, and your policy might include two benefit types. Read through your plan document carefully to determine which version you have.
- Dental plans typically pay for veneers only when medically necessary
- Cosmetic dental insurance pays for veneers for aesthetic reasons
Remember that cosmetic dental plans are not insurance because they do not protect your finances from unforeseen calamities such as decay or tooth loss.
Health Insurance
Your health insurance might cover dental veneers when it deems the procedure as medically necessary under a stricter definition: arising from non-biting accidents, certain diseases, and treatments considered as integral to other included services.
The bar for health insurance is much higher because coverage generally stops inside the mouth – even though our teeth and gums are a critical part of the body. You must connect the veneers to another covered service.
For example, a broken tooth caused by a non-biting accident would need to include injuries to other parts of your body to qualify – such as a broken jaw.
Also, health insurance will not cover any decay-related services or cosmetic work under any circumstances.
Medically Necessary
You have to ask yourself when veneers are medically necessary to answer whether insurance will cover the procedure. Most dental plans will honor claims for treatments deemed medically necessary, while only a few include benefits for cosmetic procedures.
Ask your dentist to write a letter of medical necessity supporting the need for veneers to restore tooth enamel damaged by an accident, illness, or prescription drugs.
| Necessary | Cosmetic |
|---|---|
| Decay or disease | Teeth not decayed or impaired |
| Accident or injury | Teeth not injured |
| Alter bite mechanics | Enhancing aesthetics |
| Replace missing teeth |
Next, we can provide examples of when veneers might fall into the medically necessary category: when they restore enamel damaged by injury, disease, or prescription treatments.
| Necessary | Cosmetic |
|---|---|
| Broken or chipped | Fill in gaps |
| Tetracycline stains | Coffee stains/ yellowing |
| Fluoride stains | Change shape or length |
| Acid reflux | Adjust minor misalignments |
| Celiac Disease | |
| Enamel Hypoplasia |
Cost of Veneers with Dental Insurance
The average cost of veneers per tooth with dental insurance is about $1,000. However, depending on several critical factors, you could pay significantly more or less.
In this section, we assume your dental plan will honor claims (rare) and factor in these example expense-sharing features for illustration purposes.
- Deductible: $100
- Coinsurance: 50%
- Annual Maximum: $1,500
Composite Cost
Composite veneers with dental insurance cost about $550 to $812 per tooth, depending on how many choppers you upgrade in a single plan year.
The more teeth you fix in a single year, the higher your expenses will be because you quickly trigger the example annual maximum of $1,500. Two strategies can make veneers more affordable.
- Financing can spread the expenses out over time into installments
- Schedule treatment over two plan years to double the maximum benefit
- December: 1st set
- January: 2nd set
Composite veneers range in price from $400 to $1,500 per tooth, and we assume an average figure of $1,000 before factoring in possible claim payments.
| 1 Tooth | 4 Teeth | 8 Teeth | |
|---|---|---|---|
| Deductible | $100 | $100 | $100 |
| Coinsurance | $450 | $1,500 | $1,500 |
| Above Max | $0 | $900 | $4,900 |
| Total | $550 | $2,500 | $6,500 |
| Per Tooth | $550 | $625 | $812 |
Porcelain Cost
The cost of porcelain veneers per tooth with dental insurance will be about $800 to $1,312 because the retail prices are higher, shifting even more expenses above the example annual maximum benefit onto the patient.
Upgrading your coverage is a possible way to make treatment more affordable.
- Dental insurance with no annual maximum could support a full-mouth restoration
- Dental insurance without waiting periods could support immediate treatment
Porcelain veneers range in price from $925 to $2,500 per tooth, and we assume an average figure of $1,500 before factoring in possible claim payments.[1]
| 1 Tooth | 4 Teeth | 8 Teeth | |
|---|---|---|---|
| Deductible | $100 | $100 | $100 |
| Coinsurance | $700 | $1,500 | $1,500 |
| Above Max | $0 | $3,000 | $9,000 |
| Total | $800 | $4,500 | $10,500 |
| Per Tooth | $800 | $1,125 | $1,312 |
Lumineers Cost
The cost of Lumineers with dental insurance will be the highest, an average of about $1,400 per tooth, because most patients self-pay for this premium treatment alternative.
Lumineers are ultra-thin and highly translucent, requiring less grinding down of your original tooth structures. However, the thinner laminate makes them unsuitable for restorative treatments, meaning your dental plan is unlikely to honor claims unless it covers cosmetic procedures (rare).
Lumineers range in price from $800 to $2,000 per tooth.[2] Patients typically fund the entire amount themselves without any claims support.
Article Citations
[1] Brook West Family Dentistry
[2] Manhattan Cosmetic Dentist
