Dental restoration is a common need when teeth are lost due to accidents, age, or medical conditions. However, many people are unclear whether dental restoration costs are covered by health insurance. To avoid misunderstandings and unexpected expenses, you need to be aware of the specific regulations from your insurance provider.
If you are considering dental restoration and want to save costs using your health insurance card, this is information you shouldn’t miss. My Auris Dental Clinic also shares practical insights from cases where patients were treated using health insurance, providing you with a realistic and easy-to-apply perspective.
Are Dental Implants Covered by Health Insurance?
According to the 2014 Health Insurance Law, health insurance (BHYT) only covers dental treatment costs in cases related to pathological conditions such as tooth decay, periodontitis, infections, etc. Cosmetic dental services such as implant placement, removable dentures, or dental bridges are not covered by health insurance. This is because these are restorative procedures aimed at aesthetic improvement and do not fall within the scope of mandatory treatment under health insurance. Therefore, patients need to carefully consider the costs of dental implants and proactively manage their finances when choosing this form of treatment.
Dental Services Covered by Health Insurance
The following sections will help you better understand each covered service, applicable conditions, and practical considerations.
Dental Check-ups
Regular dental check-ups are the first and most important step in oral healthcare. When patients visit public hospitals or medical centers contracted with health insurance, general dental examinations will be covered by health insurance if there is a valid prescription from a maxillofacial specialist.
Health insurance policyholders will receive cost exemptions/reductions for examinations based on the following rates: 100% for children under 6 years old or the impoverished, 80% for general laborers, and 95% for near-poor households.
Tooth Extraction
When undergoing tooth extraction at public healthcare facilities, patients need to bring a valid health insurance card and identification documents. After a clinical evaluation by the dentist, if eligible, the cost of tooth extraction (including anesthetic drugs and instruments) will be covered as per regulations. However, cosmetic tooth extractions, for instance, for braces or orthodontics, will not be supported by insurance.
Dental Fillings
According to Decision 36/2005/QD-BYT, simple dental filling techniques are classified as basic treatments. Patients undergoing these procedures at public healthcare facilities will have the costs of supplies, materials, and examination fees reimbursed. In cases where special materials (such as aesthetic composite) are used, the patient must personally pay the difference not covered in the approved list.
Root Canal Treatment
Root canal treatment (endodontic treatment) is a mandatory procedure when a tooth suffers from pulp inflammation or pulp necrosis due to untreated tooth decay. Health insurance supports root canal treatment if the tooth can still be preserved and is prescribed by a dentist. Health insurance only covers basic materials. If the patient requests restoration with high-quality materials or a crown after treatment, this part will not be supported by insurance.
Applicable conditions: performed at a medical facility contracted for health insurance examination and treatment, with a doctor’s prescription, and a properly assigned health insurance medical record or valid referral letter.
Dental Scaling
Dental scaling is a simple procedure, often included in routine health check-up programs. Tartar is the main cause of gingivitis, bad breath, and alveolar bone loss. Health insurance supports regular dental scaling if the patient undergoes the procedure at a public hospital.
Priority beneficiaries eligible for exemptions/reductions include students, people under social policy programs, and the elderly.
Procedures and Conditions for Dental Treatment to be Covered by Health Insurance
Not all facilities accept health insurance cards for dental treatment. People should visit public healthcare facilities or dental clinics contracted for health insurance examination and treatment. This list can be found on the website of Vietnam Social Security or the local Department of Health. When undergoing examination and treatment at the correct level of care, the chances of health insurance covering a portion of the restoration costs will be higher.
- Valid Health Insurance Card
- Original ID card/Citizen ID card
- Referral letter (if treatment is outside the initial designated network)
- Treatment prescription from a maxillofacial specialist
- Medical records and X-ray films, if available
Note: The documents must prove that tooth loss affects health, not solely for cosmetic reasons. If tooth loss is due to occupational accidents or traffic accidents, the patient needs to supplement with an accident report or police confirmation.
