Best ways to know In 2023: Why is fluoride not covered insurance?

Why is fluoride not covered insurance? You may wonder why your insurance doesn’t cover this essential oral health care.

The fact is that many adult people have to pay out of pocket for their oral healthcare because fluoride is not typically covered by many insurances.

If your private insurance does not provide coverage for a fluoride dental procedure. Then what are the best options available to you to provide coverage for the cost of the fluoride dental procedure? Read on to know!

But when it comes to the option related to the insurance of fluoride dental treatment for children and seniors. They have many best government insurance options available. In this article, you will get this information in detail.

Every person needs to maintain good oral health since it is medically vital to do so to sustain overall health.

Article Highlights:

Keep reading to learn why fluoride isn’t covered by insurance and what’s the best you can do about it. Knowing the best options can help control the cost of fluoride dental procedures.

1. Why is fluoride not covered by insurance? Detail information!

2. What are the best options for an adult to minimize the cost of a fluoride dental procedure if it is not covered by insurance?

3. When is fluoride covered by insurance (for kids, adults, and seniors)?

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Fluoride toothpaste applied to a toothbrush demonstrates a form of fluoride dentistry. A glass tumbler filled with water was nearby.
What government programs are there for adults to get a fluoride dental procedure if it is not covered by their personal insurance?

Why is fluoride not covered insurance?

Mineral: To help prevent tooth decay, fluoride is a naturally occurring mineral that is added to drinking water or toothpaste.

Preventive measure: Fluoride dental procedures are considered a preventive measure rather than a treatment for a specific medical condition. Insurance companies usually cover treatment for specific medical conditions but do not provide coverage for preventive measures such as fluoride.

Future: This is because the aim of preventive dental measures is to minimize the likelihood of a future dental problem rather than to treat an existing one.

Medical research: Most insurance plans have exclusions for dental preventive measures, including fluoride. Insurers usually only cover dental treatments that have been proven effective through medical research.

Everyone: In contrast, fluoride has been shown to be effective in preventing tooth decay but is not considered necessary for everyone.

Cost-effectiveness: Insurance companies consider the cost-effectiveness of dental treatment and then determine whether to cover a dental procedure.

Inexpensive: Fluoride minerals are readily available over the counter at the pharmacy and are relatively inexpensive.

Additional: Some insurance plans may have additional exclusions for fluoride, such as limits on the number of treatments that can be covered or age restrictions.

Possible loss: There may be certain medical conditions, such as kidney disease, where the use of fluoride is restricted. Hence, insurance companies do not provide fluoride coverage to prevent any possible loss.

FDA: Fluoride is not considered a drug by FDA. Therefore it is not subject to the same regulations as drugs and is not covered by insurance. But some insurance providers may provide coverage for fluoride treatment as part of a larger dental plan.

What are the best options to minimize the cost of a fluoride dental procedure if it is not covered by insurance?

The local dental societies or professional organizations should also be contacted since they might have resources or programs that assist with the expense of dental care.

What government programs are there for adults to get a fluoride dental procedure if it is not covered by their personal insurance?

Discount plans: You can talk to your dentist about any discount plans on fluoride dental procedures.

Low-cost: You can also look into dental schools or community health clinics that offer low-cost fluoride treatments.

Pharmacies: Some pharmacies may offer over-the-counter products at a lower cost.

Resources: You can contact local professional organizations or dental societies as they may offer programs or resources to help you with fluoride dental care costs.

Medicaid: You should check whether you are eligible for Medicaid as this may cover fluoride treatment for low-income individuals depending on the state and the specific plan.

Expanded: You should also check whether your state has expanded its Medicate program to cover adults and whether it covers fluoride treatment.

Clinics: You can check out Community Health Centers, which are federally-funded clinics. These programs provide primary care services or dental care to underprivileged communities.

Low-income: You can check out the different programs available in your state for dental care procedure, including fluoride treatment for low-income individuals and families.

Charities: Some non-profit organizations and charities may also offer to provide resources and funding for other dental care, including fluoride treatment.

Free: Local health departments may provide low-cost or free dental services to people with specific income requirements.

Through which dental insurance plan can children in the United States receive fluoride dentistry?

1. By your employer: Through dental insurance plans offered by your employer, you can get fluoride treatment for your children as a covered benefit if it is available in your dental insurance policy.

2. Through Medicaid

3. Through State Children’s Health Insurance Program (SCHIP)

4. The Affordable Care Act (ACA)

Note: Fluoride dental services may vary from state to state so you should check.

Through which dental insurance plans can seniors in the United States receive fluoride dentistry?

1. Through Medicare: Medicare is a government-funded insurance program for people 65 and older. Senior citizens can get coverage for fluoride treatment through this if the facility is available in your state.

What are the essential things if a fluoride dental procedure is not covered through insurance, knowing how you can control the cost of this procedure?

Spend: In this situation, if a person does not get the coverage of fluoride dental treatment through insurance, then they have to spend the cost through their own pocket.

Confidently: If you want to manage the cost of fluoride dental procedures out of your pocket, then there are a few essential things you need to know so that you will not have any doubts and can carry out your oral care confidently.

Essential questions: The information below introduces you to the essential questions of fluoride dental treatment and knowing which you can gain confidence in yourself for this dental procedure.

What does the fluoride treatment do?

Mineral: Fluoride is a mineral naturally present in foods and water.

Resistant: When fluoride past is applied to teeth, it is absorbed into the enamel making it more resistant to attack by sugar and plaque bacteria in the mouth.

Initial: Fluoride can also help reverse the initial decay by remineralizing the enamel on the teeth.

Apply: In-office fluoride dental treatments are usually applied as a varnish, foam, or gel and may be painted onto the teeth.

Few minutes: The fluoride is left on the teeth for a short time before rinsing. This type of treatment usually only takes a few minutes.

Home: Fluoride treatment at home is usually done through toothpaste or mouth rinse that can be used daily.

Pharmacy or dentist: Fluoride products can be bought over the counter at a pharmacy or prescribed by a dentist.

Dental benefits: Adults and children at high risk of tooth decay may receive healthy dental benefits from additional fluoride treatment.

Supervision: Fluoride treatments under the supervision of a qualified dentist are usually effective and safe.

Cosmetic: Excessive consumption of mineral fluoride can lead to dental fluorosis, a cosmetic condition characterized by white spots on the teeth.

Preventive measures: Fluoride treatment can be used with other preventive measures such as regular dental checkups and good oral hygiene.

Evidence: Dental and medical evidence shows that fluoride toothpaste and mouth rinses can reduce cavities by up to 40%.

Best result: It is essential to follow the instructions given by your dentist and use the fluoride treatment as directed for the best results.

Can I do my own fluoride treatment?

Accurately: Fluoride treatments are usually directed by a dentist. They have the equipment and expertise to accurately apply fluoride and ensure that the correct amount is used.

Substitute: Pharmacy over-the-counter fluoride products such as fluoride rinses or fluoride toothpaste may be used at home as part of an oral care routine. But these products are not a substitute for professional fluoride treatment.

Varnish or gel: Commercial fluoride treatments such as fluoride varnish or gel are usually more concentrated than over-the-counter products and can be applied more precisely and controlled manner.

Equipment or training: Attempting to do a fluoride treatment on your own without equipment or training can lead to overuse of fluoride, which can harm your oral health.

Discolouration: Applying too much fluoride to the teeth can lead to fluorosis, which causes tooth discolouration.

Accurately determine: Fluoride treatment should be tailored to the individual’s dental needs. A dentist can accurately determine the appropriate type and frequency of fluoride treatment for each individual.

Own fluoride dental treatment: If you want to do your own fluoride treatment, you should talk to your dentist first to ensure it is safe for you to do so.

Stay within: It is essential to follow the fluoride product’s packaging directions carefully and stay within the prescribed dosage.

Checkups and cleanings: Regular dental checkups and cleanings are essential even if you are doing your own fluoride treatment because they allow a dentist to monitor your oral health and adjust your treatment plan as needed.

Teeth and gums health: Remember that fluoride treatment is just one aspect of maintaining good oral health. It is also important to brush regularly, eat a healthy diet and avoid smoking or excessive alcohol consumption to keep your teeth and gums healthy.

Is fluoride varnish necessary for children?

Recommend: Dentists often recommend fluoride varnish for children as they are more prone to tooth decay due to their developing teeth and tendency to consume sugary foods.

Helps to strengthen: Fluoride varnish can effectively reduce the risk of cavities in children as it helps to strengthen the enamel of the teeth and make them more resistant to decay.

At least twice: The American Academy of Pediatric Dentistry recommends fluoride varnish at least twice a year for children at high risk of tooth decay.

Minimal side effects: Fluoride varnish is a safe treatment for children with minimal side effects and is easy to apply.

Flossing and brushing: Fluoride varnish is also beneficial for children who have difficulty flossing and brushing their teeth properly.

Reduce the need: Fluoride varnish may also reduce the need for more expensive dental procedures such as extractions or fillings in children.

Accessible preventive measure: Most insurance plans and Medicaid generally cover fluoride varnish for children; it is an accessible preventive measure for many children.

Hygiene habits: Fluoride varnish is just one aspect of maintaining good oral health for children. It is essential to inculcate good oral hygiene habits such as flossing, brushing regularly and visiting the dentist twice a year, and limiting sugary foods in your diet.

Does insurance provide fluoride treatment coverage for children?

Infants and children: According to, Fluoride varnish is recommended by the U.S. Preventive Task Force and the American Academy of Pediatrics for all infants and children starting at age 5.

6 months: According to their recommendation, all children in this age group must apply fluoride varnish at least once every 6 months. Coverage is mandated at no cost to families under the Affordable Care Act, so most private insurers cover the varnish procedure.

Most DeltaCare® USA and Delta Dental PPO™ plans provide coverage for fluoride treatment for children up to age 12, with many providing coverage for such treatment up to age 18 and for adults as well. Typical codes of fluoride treatment are shown below.

1. D1208 Topical application of fluoride excluding varnish

2. D1206 Topical application of fluoride varnish

Significantly improve: Preventive dental care is essential for individuals of all ages, and you should encourage your pediatric patients to have regular fluoride treatments at all times. Clinical workflow that involves the application of fluoride treatment Children’s oral health can be significantly improved with this effort.

Are fluoride treatments recommended for seniors?

As we age, our teeth become more vulnerable to decay and cavities. Fluoride treatment can strengthen tooth enamel even at an older age and may help prevent the formation of cavities.

Help seniors: Luckily for seniors, they can get fluoride dental treatment through Medicare. Let’s look at how fluoride treatment can help seniors avoid dental problems.

Dry mouth: Fluoride treatment is primarily beneficial for seniors who have dry mouths because a decrease in saliva can lead to an increase in cavities.

Fixed-income seniors: Fluoride treatments are relatively inexpensive even without insurance, making them a cost-effective medical option for fixed-income seniors.

Bone loss: Fluoride treatment may also help prevent bone loss in seniors because fluoride is essential for developing and maintaining strong bones.

Bacteria-free: Fluoride treatment is beneficial for senior citizens with dental work like bridges or dentures as it helps to clean and make those areas bacteria-free.

PH levels or dry mouth: Fluoride therapy may be helpful for seniors who take medications that affect pH levels or dry mouth.

Effortless: Fluoride treatment is available in various forms, such as varnishes, foams, rinses, and gels, thus making their use effortless for senior citizens.

How often should adults get fluoride treatment?

6 months: The general recommendation for fluoride treatment for adults is to have it every 6 months during routine dental check-ups and cleanings.

Higher risk: These adults present a higher risk of tooth decay and may require more frequent fluoride treatments.

History of tooth decay: Adults with a history of tooth decay or cavities may be recommended a fluoride treatment every 3 months, but this should be done through a dentist’s advice.

Acid erosion: Adults consuming many acid-rich foods, such as carbonated drinks and citrus fruits, may need a more intensive fluoride treatment to protect their teeth from the effects of acid erosion.

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Frequently Ask Questions about “why is fluoride not covered insurance” is commonly asked by people.

Is fluoride toothpaste covered by insurance?

Improbable: Dental insurance plans generally provide coverage for fluoride treatment for children rather than for adult individuals. You should check your insurance plan to check what is and is not covered by your dental insurance plan. It is improbable that your dental insurance plan will give you coverage for fluoride toothpaste because it is affordable for everyone.

How long is fluoride covered by insurance?

According to the Children’s Health Insurance Program (SCHIP) and Affordable Care Act (ACA), children can get fluoride dental treatment through insurance till the age of 12; years and according to some state health policy it can be up to 18 years of age. Seniors over 65 are eligible to receive fluoride dental treatment through Medicare. If an adult is eligible for the Affordable Care Act, they are more likely to receive fluoride treatment.

Is fluoride considered preventive care?

The following things are included prominently inside preventive dental care, it is shown below:

1. Teeth cleaning
2. Routine X-rays
3. Regular oral exams, usually every 6 months

This means that preventive dentistry is dental care that helps maintain good oral health. These include a combination of regular dental checkups as well as developing good habits such as flossing and brushing.
No surgery: Fluoride treatment is used to reduce the effects of bacteria on the gums and cavities. When fluoride paste is applied to the teeth and gums, it resists attack by bacteria. Because no surgery is done in this procedure, therefore this dental procedure is considered under preventive dental care.

How long does fluoride stay on teeth?

Periods of time: Depending on the type of fluoride, fluoride stays on the teeth for different periods of time. Topically applied fluoride from mouthwash or toothpaste will stay on the teeth for a short time.
Fluoride supplements: Systemically applied fluoride such as community water fluoride fluoridation or fluoride supplements remain on the teeth for a long time because it is incorporated into the developing dental structure.
Varnish applied: Fluoride treatments usually come from a varnish applied to the teeth. It typically stays on the teeth for a period of 4 to 6 hours before being washed off with a toothbrush.

How long after fluoride treatment can i drink coffee?

If you have had a fluoride treatment on your teeth, you should allow it to remain on your teeth and gums for 4 to 6 hours and avoid drinking hot liquids such as coffee or tea to get the best results. Following specific guidelines after fluoride treatment, you will never get accurate results.


Why fluoride is not covered by insurance. The answer is not simple, although fluoride effectively prevents tooth decay.

Medically necessary: Insurance companies do not consider the need for fluoride to be a medically necessary treatment, so the cost of fluoride treatment can be high.

Skip: This may mean paying for fluoride treatments out of pocket or not receiving them at all. This doesn’t mean you should skip the fluoride treatment altogether.

Lower cost: Instead, it is a good idea to ask your dentist about alternative methods of preventing tooth decay and how to get the cost of this dental procedure done at a lower cost that may not be covered by your insurance.

Taking care of your oral health is essential, and fluoride is integral to that. Don’t let insurance coverage keep you from getting the care you need.

Thank You.

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