Does medical insurance cover impacted wisdom teeth

How much does wisdom teeth removal cost with and without insurance in 2022?

My daughter recently had all four of her impacted third molars (wisdom teeth) pulled by an oral surgeon, who charged $3,155 for his services. Her responsibility (mine really) totaled only $508.

I have Explanation of Benefits (EOB) statements from Aetna (Medical) and Delta Dental, breaking out provider charges, insurance payments, contracted rates, and the remaining patient responsibility for each service.

You will be surprised and encouraged by the many avenues available to keep the amount you must pay to a minimum – even if you do not have dental insurance already in force!  

How much wisdom teeth removal with insurance in 2022 depends on the type of coverage you have, the cost-sharing features embedded in the plan, the complexity of the procedure, and the type of provider.

• Pulling gum-impacted third molars is a simple service performed by a general dentist using local anesthesia
• Pulling bone-impacted third molars is a complex procedure performed by an oral and maxillofacial surgeon using general anesthesia

Medical Insurance

Bony-impacted wisdom teeth removal costs with medical insurance in 2022 are typically lower even though the procedure is more involved and requires treatment by an oral and maxillofacial surgeon.

Medical insurance covers wisdom teeth extraction when medically necessary. Jawbone-impacted third molars fit this definition because they can cause pain, infection and lead to the development of cysts.

Your out-of-pocket costs will depend on your healthcare plan’s expense-sharing features as illustrated by my daughter’s EOB from Aetna: annual deductible ($1,500), copayments ($0), and coinsurance (40%).

Dental Insurance

How much it costs in 2022 to get wisdom teeth removed with dental insurance depends on whether you are having bony-impacted or soft-tissue impacted third molars pulled, and the expense sharing features built your plan for oral care.

Bone-Impacted

Bony-impacted wisdom teeth removal costs with dental insurance are smaller because the medical plan pays first (primary), and the dental plan coordinates benefits as the secondary payer on any remaining amounts.

Plus, dentists cannot charge more than the contracted or allowed amount when choosing an in-network provider, as illustrated by my daughter’s EOB from Delta Dental, who used a participating oral surgeon to realize significant savings.

Your remaining out-of-pocket costs will depend on your dental plan’s expense-sharing features. In my daughter’s case, her net responsibility totaled $508 after Delta Dental applied her deductible ($50) and coinsurance (20%) to the discounted allowed amount.  

Gum-Impacted

The cost of soft-tissue impacted wisdom teeth removal with dental insurance could be much higher even though the provider price points are lower. Your medical plan does not deem non-surgical extraction of third molars as medically necessary.  

Dental insurance annual maximums limit the benefits paid each year and are more likely to kick in when your medical plan does not honor claims as the primary payer. For instance, my daughter’s yearly maximum was $1,500.

In this case, your out-of-pocket costs could range from $307 to $1,285. Your final answer depends on other oral care services billed to the plan earlier in the year.

• $307: the four extractions were the first service billed
  • $50 deductible
  • $257 in coinsurance at 20%
• $1,285: other services eclipsed the annual limit

Medicaid Insurance

The cost of wisdom teeth removal with insurance is often much lower for low-income Medicaid recipients in 2022. This publically-funded program acts as healthcare throughout the country but covers oral care for adults differently in each state.

Wisdom teeth extraction is free when Medicaid covers the treatment because participating providers cannot balance bill patients. However, the odds of this happening vary.

• Medicaid pays for the extraction of bone-impacted third molars across the country because it works like health insurance in these instances.
• Medicaid covers dental work for adults in about half of the states, meaning it will pay for the extraction of gum-impacted third molars based on where you live

Wisdom Teeth Removal Cost Without Insurance

The answer to how much is wisdom teeth removal without insurance in 2022 might surprise you because the answer is often radically different for the extraction of bone-impacted versus gum-impacted third molars.

The need for the procedure should not come as a surprise, meaning you have plenty of time to make the necessary steps to minimize your expenditures.

Bony-Impacted

The cost of bone-impacted wisdom teeth removal without insurance should be irrelevant in 2022. Healthcare plans cover the procedure because it is medically necessary, leaving most people with minuscule out-of-pocket expenses.

Those currently uninsured have at least three avenues to get cheap coverage.

1. Medicaid begins immediately for low-income households living below federal poverty guidelines
2. Children’s Health Insurance Plan (CHIP) helps families who make too much to qualify for Medicaid and begins immediately
3. Private health insurance covers pre-existing conditions without a waiting period and includes subsidies to make the premiums more affordable

Apply at the healthcare.gov website if you do not have health insurance.

Soft-Tissue Impacted

The cost of gum-impacted wisdom teeth removal without insurance of any kind causes the most pain when patients have no way of getting a third party to bear the burden in 2022.

Dental financing with bad credit can help uninsured patients raise enough money. Budget the projected costs of about $1,900 to extract all four soft-tissue impacted third molars.

• Removal – Soft Tissue (4): $1,400
• Therapeutic Drug Injection (1): $85
• Local Anesthesia: $300
• Panoramic Radiographic Image: $115