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Does Dental Insurance Cover Night Guards?
by Dylan Hao |
When you’re dealing with problems like teeth grinding and TMJ (temporomandibular joint), a night guard might be the best solution.
But the cost is keeping you from giving it a shot.
If you have dental insurance, the coverage can offset much of your treatment. Yet insurance policies often will not pay for your night guard itself.
Still, you have plenty of options that fit your budget.
How can you get a high-quality dental night guard without paying an arm and a leg?
We have the answers for you here in this article; read on to find out!
Why Dentists Prescribe Night Guards
Your dentist or doctor may have suggested a night guard for your condition, which means it’s a “prescribed” treatment. Unlike your medical prescriptions, this doesn’t guarantee that your insurance company will cover the night guard.
The factors determining insurance coverage can include your insurance plan’s general coverage limits, the diagnosis itself, or your condition’s severity and symptoms.
Night guards work well to counter symptoms from health issues such as:
- Bruxism
- Sleep apnea
- TMJ disorder
Each of these is a medical condition you’d see your physician for help with, and each one comes with oral health complications.
Let’s examine why your doctor might prescribe a night guard for your diagnosis.
Bruxism
Bruxism is a condition that causes you to bite, grind, and/or clench your teeth and jaw unconsciously. This usually occurs when you’re asleep, but there is also a type of awake bruxism.
Because you’re clenching and grinding without realizing it, the force of the action erodes the enamel in your teeth.
The jaw, facial, neck, and shoulder muscles are overworked, which may cause headaches, discomfort, and sometimes significant pain in those areas. There is even the risk of biting your tongue while sleeping.
Night guards are durable layers of protective material that look like a retainer. You put the guard over your teeth, forming a barrier keeping the upper and lower teeth from touching.
This limits your body’s ability to damage the teeth and muscles, making it an effective treatment for bruxism.
Read more: Stress And Bruxism: How To Stop Teeth Grinding
Sleep Apnea
Obstructive sleep apnea, or OSA, is a sleep-related breathing disorder where your breathing repeatedly stops and restarts while you’re asleep. This happens because your throat muscles relax too much, blocking your airway.
Sleep apnea has various symptoms, with snoring being the main one.
It also shows up as:
- Daytime fatigue
- Morning headaches
- Dry mouth
- High blood pressure
- Trouble concentrating
Night guards designed to treat OSA work by moving the lower jaw forward, opening the airway. Other guards adjust and secure the tongue, preventing it from rolling backward and creating an obstruction.
Talk to your physician to get medical advice before you try a night guard for any sleep disorders.
TMJ Disorder
Temporomandibular joint disorder, best known as TMD, is a general term for any condition that affects the TMJ.
This joint is on each side of your mouth, connecting your jawbone and skull and moving like a sliding hinge. When it’s damaged, this sliding motion is blocked, and you have difficulty moving your jaw.
TMDs can be mild, severe, or somewhere in between. They may go away on their own, or they might need help.
Common causes of TMD include (but aren’t limited to) genetics, jaw injuries, and arthritis.
Typical side effects of TMD are:
- Jaw pain
- Achiness around your ears
- Facial pain
- Trouble chewing
- “Popping” of the joint
Some people develop bruxism because the pain in the jaw encourages them to clench or grind in their sleep.
When a night guard is used as part of a TMD treatment, it keeps the teeth apart, letting the jaw muscles relax.
A Prescription Doesn’t Guarantee Coverage
Your dental insurance plan might pay for your night guard with a doctor’s prescription and top-tier coverage. If so, congratulations!
You have the cream of the crop policy.
Most dental plans cover preventative care, such as cleanings and x-rays.
Chances are, even with a doctor’s order, your insurance won’t pay for the night guard. But it may help cover the cost of any dental treatment associated with the condition you need the guard for.
As with all insurance claims, it depends on the code used to bill the service and the insurance provider.
Types of Prescription and Non-Prescription Night Guards
When a night guard is the next step in your treatment plan, you must learn the difference between the three kinds before you buy one.
Prescription and non-prescription oral appliances come in stock, boil-and-bite, and custom-fit.
Stock and Boil-and-Bite
Stock and boil-and-bite are available at most drugstores.
Stock is the cheapest option. You’ll find them in small, medium, and large sizes, but they’re not guaranteed to fit your mouth. Be cautious about using stock guards, as the wrong fit can do more harm than good.
Boil-and-bite guards are also inexpensive and can be found over the counter. These are somewhat customizable. You use boiling water to soften the material and wait until it cools down. Then you bite down on it until the material molds over your teeth.
The guard adjusts into the same form as your bite.
However, it doesn’t get the nooks and crannies of your teeth’s unique shape.
Custom Night Guards
A custom night guard is created to mold specifically to your teeth.
These are individually designed for your comfort and needs, so you’ll find they’re a little more expensive but of much higher quality.
You can have them custom-made by your dentist or order them directly through the mail from professionals like us at JS Dental Lab.
Using a professional, both your preferences and the severity of your condition are considered.
Our night guards are available in:
They are made from Polyethylene terephthalate, commonly known as PETG, PET, and Ethylene-vinyl acetate (EVA).
Prescription Codes and What They Mean
So, what are your best chances at getting a night guard covered?
The key is in the prescription code.
There are three types of night guards that have insurance codes. In certain situations, these could be covered by your insurance.
Check with your insurance company if your doctor wants you to have one of these guards:
- D9944 Occlusal Guard - Hard dental appliance with a full arch
- D9945 Occlusal Guard - Soft dental appliance with a full arch
- D9946 Occlusal Guard - Hard dental appliance with a partial arch
Some insurers may cover these codes for some diagnoses.
For instance, some United Healthcare plans cover occlusal guards for bruxism with a limit of one guard every 36 months.
However, they don’t cover the code if it’s used for orthodontic work, TMJ, headache treatment, or prevention of sports injuries.
Non-Prescription Night Guards
On the other end of the spectrum are the non-prescription guards.
These include stock, boil-and-bite options, and custom guards like our mail-order kit.
If your insurance doesn’t cover the high-quality custom guard — or your copay/deductible makes it unaffordable — JS Dental Lab solves the problem.
If you’ve had any of these types of oral appliances prescribed, our professionals make it as easy as possible to get your custom-made night guard.
For instance, our extra durable guard could fill the “hard night guard” description if you need a hard appliance full arch.
You don’t have to leave your home except to go to your mailbox, and if you need any help, our friendly experts are available within minutes.
Questions? Contact us now.
How To Cut Costs When Your Insurance Doesn’t Pay
The cheapest way to get a night guard is to go to your local pharmacy and grab a boil-and-bite version.
But remember, this one-size-fits-most appliance may do more harm than good.
Whether you’re dealing with oral health issues from bruxism, TMD, or something else, you need a reputable solution.
An over-the-counter night guard that doesn’t fit your teeth and gums can aggravate other conditions, such as:
- Gum disease
- Gum inflammation
- Cavities
- Old dental fillings or crowns
Cheap guards made from soft plastic are easy to bite through, too.
Bruxers have a hefty bite force of up to 250 pounds. Someone with moderate to severe grinding and jaw clenching could destroy the guard in one use.
The saying, “You get what you pay for,” applies to night guards. Buying an OTC guard because it’s cheap can be the same as throwing away your cash.
Instead of wasting your money on an OTC night guard, look into these options.
HSA/FSA Account
Health savings accounts (HSAs) and flexible spending accounts (FSAs) are accounts funded by pre-tax money.
HSAs are used in tandem with high-deductible insurance plans. When you add money into your HSA account, you can use it to pay for any of your medical bills, including custom night guards. They roll over indefinitely if you don’t use the funds in a calendar year.
On the other hand, an FSA account is only available through your employer. The employer funds part of the account, and you invest the other part. The money you both include is not taxable. But if you don’t use the funds, they do not roll over.
Savings Plans and Reimbursements
Dental savings plans are another way to cut costs.
These work like a membership at your favorite store. You pay the annual membership fee, and when you go to any dental care provider in that plan’s network, you get discounts on your custom night guard and other services, even dentures and splints.
You could also pay out of pocket and try to get partially reimbursed by your insurance company. Some indemnity plans are lenient about the services they allow if you pay upfront and submit a claim yourself.
JS Dental Lab
Custom night guards don’t have to be expensive in the first place.
The bulk of the cost comes from the many visits to the dental office it takes to get fit for one.
When you use JS Dental Lab, you cut these unnecessary costs out of the picture.
Our night guards are made of comparable high-quality material, so you get premium appliances without going to the dentist and dealing with constant copays.
Consider the Costs Without Your Night Guard
If you’re still on the fence about investing in your health with a night guard, remember that your problems will likely worsen without one.
A night guard can minimize your symptoms and reduce the need for future medical and dental treatment. The side effects of teeth clenching, sleep apnea, and TMJ may start mild and annoying, but they don’t always go away on their own.
By the time you head to your dental professional for TMJ treatment, you could be spending hundreds of dollars or hundreds of thousands of dollars. And insurance companies rarely include TMJ coverage.
Dental treatment for tooth wear and damage due to grinding can also cost a ton to fix — and we won’t even talk about the painful dentistry procedures involved.
Investing in a high-quality, medical-grade night guard is worth the price when it saves you from future pain to your body and wallet.
Conclusion
Ready to see if a night guard can make all your (oral) problems go away?
Check with your insurance to see what your coverage includes, if anything.
Then contact JS Dental Lab for your professional custom-fit night guard. Our company makes investing in dental health easy, painless, and cost-effective.
Shop now for your custom night guard.