In 2025, in Nanchang, Jiangxi, there are some differences in dental reimbursement between the first - tier medical insurance and the second - tier medical insurance. Generally, for basic dental treatment projects that meet the regulations, the reimbursement ratio of the second - tier medical insurance is slightly higher than that of the first - tier medical insurance in some cases, but the overall difference is not extremely large. Here are the details:
- Reimbursable dental projects:
- First - tier medical insurance: Similar to the second - tier, it covers basic dental treatment items such as filling teeth (using basic materials and treatment fees), tooth extraction, and treatment of periodontal diseases like gingivitis. For example, when filling teeth due to caries, if the treatment is carried out in a designated medical institution, the relevant costs can be reimbursed according to regulations.
- Second - tier medical insurance: Also includes filling teeth, tooth extraction, and treatment of periodontal diseases. The scope of reimbursable projects is basically the same as that of the first - tier medical insurance.
- Reimbursement ratio:
- First - tier medical insurance: In general, in a public hospital at the first - level, if the cost of dental treatment is within the scope of reimbursement, the reimbursement ratio may be around 80% (for basic drugs, it may be 90%). In a second - level public hospital, the reimbursement ratio is about 70%, and in a third - level public hospital, it is approximately 60%. For example, if the cost of tooth extraction in a second - level hospital is 1000 yuan (meeting the reimbursement scope), the amount reimbursed by the first - tier medical insurance is 1000×70% = 700 yuan, and the individual needs to pay 300 yuan.
- Second - tier medical insurance: In a first - level public hospital, the reimbursement ratio for dental treatment is 85% (90% for basic drugs). In a second - level public hospital, it is 70%, and in a third - level public hospital, it is 60%. Using the previous example of tooth extraction in a second - level hospital with a cost of 1000 yuan, the amount reimbursed by the second - tier medical insurance is also 1000×70% = 700 yuan. However, in a first - level hospital, if the cost of dental treatment is 1000 yuan, the amount reimbursed by the second - tier medical insurance is 1000×85% = 850 yuan, which is 50 yuan more than that of the first - tier medical insurance.
- Limitations:
- First - tier medical insurance: For dental treatment, there are also limitations. Items such as tooth implants, porcelain teeth, teeth whitening, and orthodontics are generally not covered by reimbursement. These are considered dental aesthetic restoration projects. Also, treatment in non - designated medical institutions cannot be reimbursed.
- Second - tier medical insurance: Has the same limitations as the first - tier medical insurance. Dental aesthetic restoration projects like tooth implants, porcelain teeth, teeth whitening, and orthodontics are not within the reimbursement scope, and non - designated medical institution treatment is not reimbursable.
In conclusion, when it comes to dental reimbursement in Nanchang in 2025, the first - tier and second - tier medical insurances have some similarities and differences. The second - tier medical insurance has a slightly higher reimbursement ratio in first - level hospitals. However, both have limitations in terms of non - reimbursable aesthetic restoration projects. It is recommended that residents carefully understand the local medical insurance policy before dental treatment to better plan their medical expenses.