Are Night Guards Covered by Dental Insurance?

March 26, 2025

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.