Night guards can be a lifesaver for teeth grinders—but they can also be expensive. If you’re relying on insurance to help with costs, you might be wondering:
“Does my dental plan cover night guards?”
The answer isn’t always straightforward. Coverage depends on your insurance provider, plan type, and medical necessity. Here’s what you need to know before buying one.
When Does Insurance Cover Night Guards?
1. Medical Necessity (Bruxism or TMJ Diagnosis)
Most insurers require:
✔ A dentist’s prescription (stating it’s medically necessary)
✔ Proof of teeth grinding damage (e.g., worn enamel, jaw pain)
✔ TMJ disorder documentation (if applicable)
2. Plan-Specific Coverage
-
PPO Plans: More likely to cover (typically 50-80%)
-
HMO Plans: Less likely, but some offer discounts
-
Medicare/Medicaid: Rarely covers (considered “non-essential”)
3. Annual Maximums & Deductibles
Even if covered, you may still pay out of pocket if:
-
You haven’t met your annual deductible
-
The cost exceeds your plan’s yearly maximum (often 1,000−1,500)
How to Check Your Insurance Coverage
1. Call Your Provider
Ask:
-
“Does my plan cover occlusal guards for bruxism?”
-
“What percentage is covered?”
-
“Do I need pre-authorization?”
2. Ask Your Dentist’s Office
Many offices verify insurance before ordering a guard.
3. Review Your Plan Documents
Look for terms like:
-
“Night guard”
-
“Occlusal guard”
-
“Bruxism appliance”
What If Your Insurance Doesn’t Cover It?
Don’t skip protection—try these affordable alternatives:
✅ FSA/HSA Funds – Many plans allow using these for night guards.
✅ Online Dental Labs – Custom guards for ~150−300 (vs. $500+ at a dentist).
✅ Payment Plans – Some dentists offer financing.
✅ Discount Dental Plans – Reduced fees for members.
💡 Tip: New Smile Life offers high-quality custom guards at a fraction of dental office prices.
Final Verdict: Will Insurance Pay?
| Scenario |
Likely Covered? |
| Diagnosed bruxism/TMJ |
✅ Yes (50-80%) |
| Preventive use (no damage yet) |
❌ No |
| HMO plan |
❌ Rarely |
| Medicare/Medicaid |
❌ Almost never |
Pro Tip: Even if denied, submit a claim anyway—some insurers approve on appeal.
FAQ
Q: How much does a night guard cost without insurance?
A: 100−600 (OTC boil-and-bite vs. custom dental lab).
Q: Can I use my medical insurance for a night guard?
A: Only if TMJ-related—check with your provider.
Q: Does insurance cover replacements?
A: Often every 3-5 years—confirm with your plan.
Need an affordable custom guard? Check out New Smile Life’s options.
Night guards can be a lifesaver for teeth grinders—but they can also be expensive. If you’re relying on insurance to help with costs, you might be wondering:
“Does my dental plan cover night guards?”
The answer isn’t always straightforward. Coverage depends on your insurance provider, plan type, and medical necessity. Here’s what you need to know before buying one.
When Does Insurance Cover Night Guards?
1. Medical Necessity (Bruxism or TMJ Diagnosis)
Most insurers require:
✔ A dentist’s prescription (stating it’s medically necessary)
✔ Proof of teeth grinding damage (e.g., worn enamel, jaw pain)
✔ TMJ disorder documentation (if applicable)
2. Plan-Specific Coverage
PPO Plans: More likely to cover (typically 50-80%)
HMO Plans: Less likely, but some offer discounts
Medicare/Medicaid: Rarely covers (considered “non-essential”)
3. Annual Maximums & Deductibles
Even if covered, you may still pay out of pocket if:
You haven’t met your annual deductible
The cost exceeds your plan’s yearly maximum (often 1,000−1,500)
How to Check Your Insurance Coverage
1. Call Your Provider
Ask:
“Does my plan cover occlusal guards for bruxism?”
“What percentage is covered?”
“Do I need pre-authorization?”
2. Ask Your Dentist’s Office
Many offices verify insurance before ordering a guard.
3. Review Your Plan Documents
Look for terms like:
“Night guard”
“Occlusal guard”
“Bruxism appliance”
What If Your Insurance Doesn’t Cover It?
Don’t skip protection—try these affordable alternatives:
✅ FSA/HSA Funds – Many plans allow using these for night guards.
✅ Online Dental Labs – Custom guards for ~150−300 (vs. $500+ at a dentist).
✅ Payment Plans – Some dentists offer financing.
✅ Discount Dental Plans – Reduced fees for members.
💡 Tip: New Smile Life offers high-quality custom guards at a fraction of dental office prices.
Final Verdict: Will Insurance Pay?
Pro Tip: Even if denied, submit a claim anyway—some insurers approve on appeal.
FAQ
Q: How much does a night guard cost without insurance?
A: 100−600 (OTC boil-and-bite vs. custom dental lab).
Q: Can I use my medical insurance for a night guard?
A: Only if TMJ-related—check with your provider.
Q: Does insurance cover replacements?
A: Often every 3-5 years—confirm with your plan.
Need an affordable custom guard? Check out New Smile Life’s options.