Unlock Savings: BCBS Covered Porcelain Crowns Explained

Many seniors delay getting crowns due to cost, which is understandable when a single crown can run into thousands of dollars. But if you’re exploring BCBS covered porcelain fused to metal crowns, you’re in the right spot. In this guide, you’ll learn how Blue Cross Blue Shield handles these durable restorations, what to expect from coverage, and easy ways to keep more cash in your pocket so you can focus on your smile.

We’ll walk through classification, cost factors, treatment estimates, and tips to maximize your benefits. Ready to unlock savings? Let’s dive in.

Understand coverage basics

Blue Cross Blue Shield generally treats fixed crowns as major restorative services. That means porcelain fused to metal crowns fall under Class C procedures, where coverage is partial rather than full. You’ll usually pay coinsurance after meeting your annual deductible.

Here’s what you need to know at a glance:

• Classification: major restorative (Class C), alongside bridges and implants
• Coinsurance: typically around 50% of the allowed amount once your deductible is met
• Annual maximums: most BCBS plans cap dental benefits between $1,000 and $2,000 per year

Porcelain-fused-to-metal crowns often cost about $1,500 per tooth under BCBS plans. After a 50% coinsurance and a $50 deductible, your out-of-pocket could be roughly $700, though exact numbers depend on your specific plan.

Review Class C classification

Porcelain fused to metal crowns are classified as Class C major restorative services under BCBS FEP Dental benefits. That means you get partial coverage, but you’ll need to cover a chunk of the bill yourself.

Keep in mind:

• Prep work counts separately: if you need a root canal or post-and-core build-up before placing your crown, those are billed on top of the crown fee
• Crown lengthening or gingival recontouring might be required if there isn’t enough tooth structure—check how much BCBS covers for those procedures in bcbs covered crown lengthening procedure
• Benefit limits and waiting periods can vary by plan, so always review your Summary of Benefits

For details on coverage bundled with bridges, see bcbs covered dental crown and bridge.

Compare crown materials

Not all crowns are created equal—you’ll want to weigh durability, aesthetics, and cost before deciding. Porcelain fused to metal (PFM) blends strength and natural appearance, but other options exist:

Rely on your dentist’s recommendation—PFM crowns remain a top pick for balancing cost, strength, and a tooth-like finish.

Estimate your costs

Your final bill depends on several factors. Here’s what to track:

• Plan type: HMO or PPO affects network rules and coinsurance rates
• Network status: in-network providers have pre-negotiated fees, lowering your share
• Deductible: most BCBS plans charge $25–$50 before coverage kicks in
• Annual maximum: once you hit your plan’s yearly cap, additional costs are all on you
• Additional procedures: root canals, build-ups, or temporary crowns add fees

Example breakdown for a $1,500 PFM crown under a PPO plan:

1. Procedure fee: $1,500
2. Deductible: $50
3. Covered amount: $1,450 × 50% coinsurance = $725
4. Your total: $50 + $725 = $775

Keep in mind you may also need temporary crowns or follow-up visits, which can incur small copays or coinsurance.

Request a treatment estimate

Getting a pretreatment estimate can save surprises later. Here’s how to do it:

1. Ask your dentist for a comprehensive treatment plan, including X-rays, chart notes, and photos
2. Submit the plan to BCBS for a non-binding Explanation of Benefits (EOB)
3. Review estimated coverage, coinsurance, and any excluded items
4. Confirm whether benefit changes or eligibility updates could alter the final payment

This simple step gives you a clearer picture of your out-of-pocket before you commit. If you need help, your dentist’s office billing team can often handle the submission for you.

Choose in-network care

Using an in-network dentist keeps your costs lower and simplifies claim filing. BCBS FEP Dental has over half a million in-network providers nationwide, and 99.9% of members have at least one dentist within 15 miles.

To find your match:

• Visit the BCBS provider directory online and filter for restorative specialists
• Ask your dentist if they accept your BCBS plan—verify office billing codes
• Call BCBS customer service to double-check network status

Need help locating a provider? Try this tool for a restorative dentist accepting BCBS insurance.

Explore insurer comparisons

If you’re weighing other dental plans, here’s how porcelain crown coverage stacks up:

• Delta Dental PPO Premium: covers 50% of PFM crowns after a 12-month waiting period—learn more at porcelain crown replacement covered by delta dental
• Aetna PPO plans: typically 50% coverage for porcelain crown replacement after a waiting period—see aetna covered porcelain crown replacement
• Cigna PPO: major restorative services at 50% coinsurance, check in-network options at cigna covered permanent crown placement
• MetLife PPO: covers 50% after a 12-month wait for in-network—double-check your local provider network
• Guardian DHMO: flat copay of around $450 per PFM crown with no waiting period, though options are more limited

Comparing plans side by side helps you spot the best value for your needs and location.

Maximize your benefits

You can keep more dollars in your pocket by planning ahead:

• Use flexible spending accounts (FSA) or health savings accounts (HSA) to pay pretax for crowns
• Schedule crown work early in the year so it counts against fresh annual maximums
• Stagger multiple crowns across plan years if you’re approaching your cap
• Ask about alternative benefits if BCBS offers a less expensive crown option—any difference is your responsibility
• Coordinate medical coverage if your crown is needed due to injury covered by health insurance

These simple hacks can add up to real savings on your restorative care.

Key takeaways

• BCBS treats porcelain-fused-metal crowns as Class C major restorative services with around 50% coinsurance
• Expect to pay a deductible plus half of the allowed fee, often leaving you with $300–$800 per crown
• Always request a pretreatment estimate to clarify your coverage and out-of-pocket costs
• Stick with in-network dentists to take advantage of discounted fees and smoother claims
• Compare BCBS to other plans like Delta, Aetna, and Cigna to confirm you’re getting the best deal

Ready to restore your smile without breaking the bank? Bookmark this guide and share your experience or questions in the comments below so others can benefit too.