How to Get Dental Implants Covered by Medical Insurance
The terms of your medical or dental insurance coverage may make it unclear whether or not dental implants are eligible for subsidization. In certain cases, dental implants may be fully or partially covered by medical insurance. In other cases, they may be covered by dental insurance.
Dental implant surgery involves implanting metal tooth roots (posts) into the jaw. These posts support artificial teeth. Because many insurers consider this a cosmetic procedure, it can be complicated to understand if and how much of the treatment process is covered by your insurance plan.
When Are Dental Implants Needed?
When people lose teeth due to illness, poor oral hygiene, injury, or any other cause (see our article about When Are Dental Implants Necessary), it can have far-reaching effects. Missing teeth can change your smile, which can subsequently affect your self-confidence. Additionally, losing teeth can cause physical problems such as reducing your ability to chew effectively.
Dental implants are a common reason patients come to our Bakersfield, CA office because they provide a permanent, natural-looking solution to these problems. During the procedure, the dentist places artificial tooth roots into the jaw. These then function as supports for one or more crowns that look just like natural teeth.
Benefits of Dental Implants
Some patients find that implants are more effective than other solutions like dentures and bridgework. Dental implants have several advantages over dentures:
They are easier to maintain and therefore require fewer trips to the dentist.
There is little to no risk of implants falling out, unlike with dentures.
Implants are more comfortable than dentures.
Implants look more natural than dentures.
In a 2021 study conducted over 22 years, dental implants were reported to have a 96.7% success rate at the patient level after 5 years, with only 3.3% of patients reporting implant failures. Implants can therefore be considered long-term or even permanent solutions.
Are Implants Covered by Insurance?
All or part of the dental implant treatment process may be covered by insurance, depending on your plan. Placing dental implants typically involves four stages. Your policy may cover some of these individual stages:
Tooth extraction. If you have a damaged tooth, the dentist must remove it before replacing it. This stage is often covered by insurance companies.
Bone grafting. Because the implant needs a strong and stable foundation, some patients require their jawbone to be reinforced. This step of the procedure often isn't covered but some more comprehensive policies might contribute toward the cost.
Placement of the implant. This stage of the operation is classified as a "major" dental procedure. Some insurance policies will cover up to 50% of major procedures.
Placing the artificial tooth. The placement of the crown—the part that will resemble and function as a natural tooth—is also classed as a major procedure. However, insurance providers have different rules regarding crowns. If your policy considers the placement of the crown the same as crowning to prevent tooth decay, it may cover some of the cost.
Patients who are concerned about the cost of dental implants and potential out-of-pocket expenses should check their policy carefully and consult their insurance company before going ahead with the steps outlined above.
Dental Insurance Benefits Can Differ from Plan to Plan
The dental treatments covered by insurance will differ depending on the insurance company and the plan you have in place. Read the terms of your insurance plan to see if and to what extent your dental implants are covered by insurance.
Some Plans Don't Cover Dental Implants
Dental procedures like dental implants are considered cosmetic procedures by some insurance plans. For that reason, implant dentistry is not always covered by insurance.
Some Plans Provide Partial Coverage
Though your plan may have provisions to cover implants, it may only provide coverage for some dental services rather than the entire process. The annual maximum established in your insurance is also important in determining the extent to which your insurance will cover the dental procedure.
Because dental implant costs vary from place to place and different policies have different provisions, it's hard to make generalizations about what your plan may cover. However, there are some considerations to take into account when checking or updating your dental insurance plan:
Allowance Comparable to a Bridge or Dentures
It may be possible to request an allowance equal to the cost of a bridge or dentures from your insurance provider to use towards your implants.
Implant Placement after an Accident
In certain cases, it may be possible to claim the cost of dental implants with plans that cover the need to replace a tooth due to an accident or injury.
Read the Small Print
Even if your insurance covers dental implants, ensure you're familiar with your plan's annual limits or coverage percentages and any other costs you'll be liable for.
Exclusion of Pre-Existing Conditions
If you need implants to replace teeth you lost before your insurance plan began, ensure your insurance covers the cost of replacing them. It's best to review your policy with a fine tooth comb to avoid unexpected costs later on.
Waiting Periods
Waiting periods are also a factor in whether your policy will cover your expenses. Many policies are subject to a waiting period of several months or even a year before you can claim certain treatments like dental implants. It's wise to find out if you are subject to any waiting periods before signing up for an insurance plan or committing to treatment.
Other Factors that Can Affect Your Coverage
Some health insurance plans may cover at least some of the stages involved in dental implant surgery. For example:
If you are suffering medical issues because of your tooth loss, your medical insurance may cover the cost of dental implants.
Tooth loss that occurs as a result of oral cancer may be covered by your insurance policy.
Patients with medical and dental insurance plans may be able to pool the two policies to minimize their premiums.
Questions to Ask Your Insurance Company
Your dental office may be able to help you determine exactly what is covered by your insurance policy. However, it's worth clarifying the following to avoid any nasty surprises down the road:
Does your dental insurance cover implants, and to what extent?
If not everything is covered, what percentage of the total is covered?
What is the maximum possible out-of-pocket cost?
Are there waiting periods for dental implant coverage?
Are dental implants only covered in certain circumstances?
Do you need a referral before receiving treatment?
Combine Health and Dental Insurance to Minimize Your Costs
The placement of dental implants can not only change your smile, it can also improve your physical and mental health. Implants provide a permanent (or near-permanent) solution and prove to be a great investment for many patients.
Patients wishing to minimize their out-of-pocket costs must be clear about what their dental insurance provider covers and if their health insurance can offset any additional costs. Because your dental implant coverage may only be partial, consulting your policy is vital before undergoing treatment.