In 2025, in Yangzhou, Jiangsu, both the first - tier and second - tier medical insurance have certain regulations regarding dental reimbursement. Generally, for basic dental treatment items, the reimbursement ratios are different. For some non - basic items like orthodontics and dental implants, they are usually not covered by medical insurance. Here are the specific differences:
- Reimbursement scope
- First - tier medical insurance: Covers basic dental treatment such as filling teeth (using domestic basic materials), tooth extraction (including wisdom teeth extraction), and periodontal disease treatment. However, high - end dental services like orthodontics (traditional metal braces, invisible braces, etc.) and dental implants are generally not within the reimbursement scope.
- Second - tier medical insurance: The basic dental treatment items covered are similar to those of the first - tier medical insurance, mainly including filling teeth, tooth extraction, and periodontal disease treatment. But just like the first - tier medical insurance, orthodontics and dental implants are also usually not reimbursable.
- Reimbursement ratio
- First - tier medical insurance: In general, for basic dental treatment items, if at a primary - level medical institution, the reimbursement ratio for filling teeth and tooth extraction may be around 70% - 80% (this ratio may vary in different hospitals). For periodontal disease treatment, the reimbursement ratio may be around 60% - 70%. When it comes to secondary - level hospitals, the reimbursement ratio for these basic items may be about 60% - 70% for filling teeth and tooth extraction, and 50% - 60% for periodontal disease treatment. At tertiary - level hospitals, the reimbursement ratio for filling teeth and tooth extraction may be around 50% - 60%, and 40% - 50% for periodontal disease treatment.
- Second - tier medical insurance: At primary - level medical institutions, the reimbursement ratio for basic dental treatment items such as filling teeth and tooth extraction is usually around 60% - 70%, and for periodontal disease treatment, it is around 50% - 60%. At secondary - level hospitals, the reimbursement ratio for filling teeth and tooth extraction is about 50% - 60%, and for periodontal disease treatment, it is 40% - 50%. At tertiary - level hospitals, the reimbursement ratio for filling teeth and tooth extraction is around 40% - 50%, and for periodontal disease treatment, it is 30% - 40%.
- Reimbursement limit
- First - tier medical insurance: There is an annual maximum reimbursement limit for dental treatment. For example, the annual maximum reimbursement for outpatient dental treatment may be around 2000 - 3000 yuan (the specific amount is subject to local policies). Once this limit is reached, subsequent eligible medical expenses will not be reimbursed by medical insurance.
- Second - tier medical insurance: The annual maximum reimbursement limit for dental treatment is relatively lower than that of the first - tier medical insurance. It may be around 1000 - 2000 yuan for outpatient dental treatment. Similarly, once this limit is exceeded, no further reimbursement will be provided.
In conclusion, in 2025 in Yangzhou, Jiangsu, both the first - tier and second - tier medical insurance mainly reimburse basic dental treatment items, with the first - tier medical insurance generally having a higher reimbursement ratio and limit. For non - basic dental services like orthodontics and dental implants, they are usually not covered by medical insurance. It is recommended that you consult the local medical insurance department or the medical insurance office of the hospital before treatment to understand the specific reimbursement policies.
