Dental implants provide an excellent way to replace missing teeth and restore your smile. However, these prosthetic tooth roots and replacement teeth come at a significant cost, often $3,000-$4,000 for a single implant crown. This leads many looking into implants to wonder – will my dental insurance cover this?
Unfortunately, there is no simple yes or no answer. Dental insurance coverage of implants can vary greatly depending on your specific plan, insurance company, and reason for needing implants. Below, we’ll explore the factors that determine your dental implant coverage and steps you can take to maximize insurance benefits.
Do Dental Insurance Plans Cover Implants?
Whether your dental insurance covers implants depends entirely on your plan’s provisions for implant treatment. Many dental plans provide no implant coverage at all, especially lower-cost policies. Approval for partial coverage depends on these plan details:
- Type of Plan – PPO and indemnity plans are more likely to cover implants than HMOs or discount dental plans.
- Level of Coverage – Plans may pay a set percentage, like 50%, or up to a yearly maximum amount. Better plans reimburse more.
- In-Network vs. Out-of-Network – Using in-network dentists could mean higher coverage compared to out-of-network.
- Waiting Periods – You may need to be insured under the plan for 6-12 months before qualifying for implant coverage.
- Medical Necessity – Some insurers require proof that implants are dentally necessary and not just cosmetic.
Since policies vary widely, you’ll need to investigate your own plan’s coverage specifics to know if implants are included. Never assume they are covered.
Does Health Insurance Cover Dental Implants?
It’s very rare for health insurance plans to cover any dental services, including implants. The only potential exception is if serious trauma, like a car accident, causes tooth loss or damage.
In such cases, major medical insurance may cover implants as medically necessary, but there’s no guarantee. Health plans predominantly consider implants as an elective dental procedure excluded from medical coverage.
Medicare also does not cover routine dental treatment, including implants. Medigap plans won’t provide coverage either. Realistically, patients cannot depend on health insurance to cover any portion of implant costs.
Partial Dental Insurance Coverage for Implants
While finding a dental plan that covers implants 100% is unlikely, you may get partial coverage depending on your insurance provider and policy. Here are the aspects of implant treatment that dental insurance can potentially cover:
- Initial consultation and x-rays
- Extractions of damaged teeth
- Bone grafting to augment implant sites
- Placement of the implant posts into the jawbone
- Abutments to connect the crown
- The implant-supported crown
- Follow-up appointments to check placement
But just because a plan offers implant coverage doesn’t mean they’ll pay for your entire treatment. Make sure to understand insurance percentages, deductibles, yearly maximums, and limitations that affect how much they’ll reimburse.
Dental Insurance Coverage Differences by Implant Type
Insurance coverage can also differ depending on the type of implant treatment you receive:
- Single Tooth Implant – Replacing one missing tooth with an implant-supported crown. More likely to get partial coverage.
- Multiple Tooth Implants – Placing several implant crowns to replace multiple missing teeth. May have higher coverage limits.
- Full-Arch Implants – Replacing all missing upper or lower teeth with screw-retained implant bridges. Less coverage likelihood.
- Full-Mouth Implants – Placing implants and crowns to replace all missing upper and lower teeth. Least likely to be covered.
The more extensive the implant treatment, generally, the lower the chance that insurance will cover a portion of it. But always confirm directly with your provider.
Tips for Getting the Most Dental Insurance Coverage for Implants
While dental implant coverage is never guaranteed, you can take these steps to potentially increase insurance reimbursement:
- Compare multiple insurance plans when selecting a dental provider to find ones that specifically include implant coverage.
- Use in-network dentists for higher coverage with most plans rather than out-of-network providers.
- Have your dentist submit pre-estimates of treatment costs to get procedures pre-approved.
- Ask your dentist for proof of medical necessity if it is required by your insurer.
- Take advantage of insurance discounts like multiple family member rates.
- Carefully space out treatment over two plan years if you have a yearly coverage maximum.
- Pay attention to timing and start treatment just after your yearly maximum refreshes.
While implants may still cost you significantly out-of-pocket even with insurance, these tips can help you get the maximum reimbursement possible from your plan.
What Out-of-Pocket Costs to Expect for Implants
Since many dental insurance plans provide limited or no implant coverage, you’ll need to be prepared for likely high out-of-pocket costs. These expenses can include:
- Deductibles, co-pays, and co-insurance payments
- Any amounts above your annual coverage limits
- Services like bone grafts may not be covered
- The remaining cost after insurance payment
- Upgrade charges for premium implant materials
For a single tooth implant, your insurance may cover 50% up to $1,500 per year. If the total cost is $4,000, you would owe around $2,500 out-of-pocket. The costs are higher for multiple implants or full-arch treatments.
Getting a clear understanding of your own insurance coverage and limitations is key to avoiding unexpected expenses.
Can I Use HSA or FSA for Dental Implants?
To help manage out-of-pocket costs for implants and other dental treatment, you may be able to use tax-advantaged savings accounts:
- Flexible Spending Account (FSA) – FSAs allow setting aside pre-tax dollars to pay healthcare costs not covered by insurance. You can use FSA funds to cover uncovered implant expenses.
- Health Savings Account (HSA) – To contribute to an HSA, you must be enrolled in a high-deductible health plan (HDHP). HSA money can be utilized tax-free for dental implants as long as they are not solely cosmetic.
Both options allow you to pay for implants with pre-tax dollars, saving you money. Just be sure to save all related receipts in case you need to show proof the funds were used for healthcare.
To Recap
While it is possible, getting dental insurance to fully cover implants is extremely rare. But with the right plan and proactive steps, you may be able to get 50-75% coverage in some cases. Know your own plan details, timing of treatment, and out-of-pocket costs ahead of time to make implant surgery as affordable as possible.
Dental Implant Insurance FAQs
Here are answers to some frequently asked questions about dental insurance and implant coverage:
Does my dental insurance cover tooth extractions for implants?
Most dental plans cover extractions of damaged teeth, at least partially. This includes extracting teeth in preparation for implants. But verify the coverage amounts for this procedure with your insurer before treatment.
Can I get individual dental insurance just for implants?
Some dental insurers do offer policies specifically for major care like implants. But they come with limitations, waiting periods, and benefit maximums. Supplemental plans pay less than standard insurance.
Is bone grafting covered by dental insurance?
Unfortunately, bone grafts to augment thin jaw sections before implants often fall into coverage gaps. Some insurers consider bone grafts separate from implant treatment. Check with your provider if bone grafts are covered.
Why are implants more expensive than bridges or dentures?
The parts that make up a single implant, like the titanium post and abutment, are more complex and costly than traditional tooth replacements. There is also a higher level of skill and training required by dentists when placing implants.
How can I get discounts on dental implants without insurance?
Many implant providers offer their own discounts and financing options to self-pay patients, so always ask. Dental savings plans provide 10-60% discounts on treatments, including implants, in exchange for a low monthly or annual fee.
In another related article, Can Invisalign Be Covered by Dental Insurance? What You Need to Know
