The first question many Americans ask before receiving any medical care is, “Will my insurance cover this?”. Dental and, more specifically, teledentistry services are no different, with the deciding factor whether to undertake a procedure often coming down to your insurance coverage.
With teledentistry being a relatively new industry, many patients are unsure whether their insurance covers these new services. What follows is a closer look at that question and the role that Medicare and Medicaid play in covering teledentistry procedures.
Does Insurance Cover Teledentistry Procedures?
After patients learn the answer to the question "What is teledentistry?" their next question will undoubtedly be about whether their insurance covers these services. The short answer is maybe, while the longer one depends on several different factors. The three most significant factors influencing teledentistry insurance coverage are:
1. Where Do You Live?
Where you live could play a significant factor in determining whether your insurance covers teledentistry. Different states have different laws regarding teledentistry and what insurance companies are required to cover. Currently, 29 states require private insurance companies to cover teledentistry services the same as in-person visits. If you live in one of these states, you’re likely covered. If not, other factors may determine whether you are covered.
It’s also important to note that laws do change. While only 29 states now require coverage, it’s certainly possible that the number will increase over time.
2. Who Is Your Insurance Carrier?
Different insurance carriers will also have different policies on what they cover. If you live in a state that doesn’t force teledentistry parity, you’ll have to check with your carrier to see what they will and will not cover.
The good news is that most major carriers are moving towards covering online medical services. The proven cost savings of teledentistry are just as beneficial for insurance companies as patients. There’s a good chance your provider already covers some of these services.
3. What Is Your Policy?
It’s also the case that individual insurance policies may include language that disallows teledentistry. It’s impossible to go into detail here as every policy is a bit different, but make sure to talk to your insurance provider to see what your plan says.
Another critical factor is that the teledentistry industry is growing and changing all the time. With new regulations added every year, many insurance companies are becoming more likely to cover teledentistry services. If you’re not already covered, there’s a good chance that could change in the next few years.
Does Medicare Cover Teledentistry?
By default, Medicare doesn’t cover most dental work, so its coverage of teledentistry services is limited. In some instances, Medicare might cover your teledentistry services. In general, for Medicare to cover a teledentistry service, it must be done over a two-way video conferencing service, or fit into a list of other, limited approved needs. Due to the recent emergence of teledentistry, the laws can still be confusing here, so it’s essential to do some research beforehand.
It’s important to note that there are many supplemental Medicare plans available as well as different plans offered at the state level. These may have additional benefits that do cover teledentistry services; make sure to do the research here if this applies to you.
Does Medicaid Cover Teledentistry?
In some cases, Medicaid can also be used to cover eligible teledentistry procedures. Medicaid coverage varies depending on state laws, as some have much more comprehensive coverage than others. While Medicaid is federally mandated, it’s quite broad and leaves many details up to individual states. Federal ambiguity means there is a large number of differences in the program between states.
California, for example, has laws that fund teledentistry services with Medicaid. Many other states are also looking at similar programs. You’ll want to research your state to figure out how its Medicaid system works and if the program covers you.
Coverage also requires that the dentist providing the services participates in the Medicaid program. Nationally, only about 40% of dentists participate in Medicaid, so if you plan to use the program, it’s necessary to find a participating dentist.
What if Teledentistry Is Not Covered for Me?
If you’re not already covered by one of the above, then you still have options. As noted, laws and policies are changing quickly, so it may be the case that you’ll be covered soon.
Many teledentistry services are also much cheaper than they would be with an in-person visit. Even if you’re not covered, it still might be cost-efficient to utilize teledentistry services. Only you can make that call, but it certainly pays to shop around and see what services different providers offer and at what cost.
Teledentistry and Insurance Coverage
The key takeaway is that it’s imperative to know the laws in your state and speak with your insurance provider. While many teledentistry services are currently covered, not all are. Teledentistry is growing and evolving all the time. If you’re not covered now, keep checking back as that will likely change in the near future.