How to Get Dental Implants Covered by Insurance

How to Get Dental Implants Covered by Insurance – Getting dental implants can involve anything from one implant with a crown to multiple implants for either removable or fixed teeth. The entire process can take between three and nine months, but more complicated cases may take over a year. While it’s an effective solution for replacing a missing tooth, implants can be costly.

How to Get Dental Implants Covered by Insurance

This can make it challenging to find dental insurance that includes coverage for implants.  Many plans that do cover implants may not cover those considered cosmetic. To help you quickly regain your smile, here’s a guide on how to get dental implants covered by your insurance plan.

What are Dental Implants?

Dental implants are surgically placed in your jaw to replace missing teeth. The complete system includes three parts:

  • Implant body: a screw-like piece placed in the jawbone as a tooth root.
  • Abutment: A connector that attaches to the implant body and goes through the gums to hold a crown.
  • Crown: The artificial tooth that is secured to the abutment.

Are Dental Implants Covered by Dental Insurance Company?

Some dental insurance may help pay for part of your dental implant procedure, but the specifics depend on your plan. Your policy might not cover all expenses, leaving you responsible for a large portion of the bill. Even if your insurance covers implants, you may need to meet your deductible first. Then, your coverage might only apply to certain parts of the procedure, such as consultations, X-rays, anesthesia, and the type of crown.

The reason for needing an implantation can impact coverage. Many plans pay for implants needed after an accident but may not cover cosmetic procedures. Sometimes, your insurance might cover a portion of a cosmetic implantation, such as up to 50% of the cost. It’s important to review your policy rules ahead of time. A potential challenge is that dental plans might not cover implants for teeth you were missing before your coverage started.

Why Does My Dental Insurance Plan Not Cover Dental Implants?

Some dental insurers may exclude or limit coverage for dental implants because they view the procedure as cosmetic and not medically necessary. Coverage may also be excluded if the tooth was missing before your policy started.

Different parts of this process may not be covered, or only partially covered:

  • Tooth extraction: If a damaged tooth needs to be removed before placing the implant, insurance often covers this.
  • Bone grafting: Reinforcing the jawbone for a secure implant may not be covered.
  • Implant placement: This is a major and costly part of the procedure. Some plans may cover up to 50% of the cost, while others cover less.
  • Crown placement: The crown, or artificial tooth, goes on top of the implant. This is another significant procedure, and your plan may cover up to half of the cost.

How do I know if Dental Implants are Covered by my Insurance Policy?

When reviewing a dental insurance policy or talking to a provider, ask the following questions:

  • Does the policy cover complete dental implantation systems, including the implant, abutment, and crown?
  • Is there a waiting period before the policy covers the implantation?
  • What is the plan’s maximum coverage limit?
  • Is there a yearly or lifetime cap on the dollar amount covered for implants?
  • What portion of this system will I need to pay for?
  • Is the coverage percentage different for the implant and the crown?
  • Do I have to pay a deductible before the coverage starts, and if so, how much is it?
  • Are procedures like extractions or bone grafts covered, and do they require a copay or coinsurance?
  • Is post-op and pre-op care covered?

Dental implants involve several elements, like abutment, crown, and care before and after the procedure. Make sure to ask about each part to understand what you may have to pay out-of-pocket.

Does Health Insurance cover Dental Implants?

Health insurance usually doesn’t cover dental implants unless they are medically necessary due to a severe injury, like a car accident damaging your mouth. Medicare plans may also cover implants if they are medically necessary. Finding a dentist who can perform implants and accepts health insurance or Medicare for dental procedures can be quite challenging.

Dental Implant Cost

The cost of this implantation process with insurance depends on your dentist’s fees and how much your insurer covers. Among 13 insurers, coverage for implants and crowns ranged from 10% to 50% after meeting your deductible. So, if the implant costs around the average of $2,000, your out-of-pocket cost with insurance could be between $1,000 and $1,800 per implant, assuming you’ve met your deductible. This only covers the implant body.

You’ll also need to pay for the crown and abutment that go with the implant. With insurance, the average cost for an implant-supported porcelain crown ranges from $755 to $1,360, and a pre-fabricated abutment costs between $358 and $645. Together, the average out-of-pocket cost for an implant, abutment, and crown ranges from $2,113 to $3,805, depending on your insurance coverage. Additional expenses may arise if you need a bone graft or tooth extraction.

How to Choose the Best Dental Insurance Company For Implants

If you wish to go ahead with dental implantation, consider the following factors when going around to shop for a dental insurance plan: 

  • Premium: The monthly cost you pay to keep your coverage active.
  • Deductible: The sum you cover personally before your insurance coverage activates.
  • Annual max benefit: The maximum the plan will pay for your dental care each year.
  • Annual implant maximum: The most the plan will cover for implants each year.
  • Lifetime implant maximum: The total amount the plan will pay for implants over your lifetime.
  • Implant coverage percentage: the portion of the implant cost that the insurer will pay.
  • Crown coverage percentage: the part of the crown cost the insurer will cover.
  • Waiting period for implants: The time you must wait before your insurance starts covering implant costs.
  • Waiting period for crowns: The waiting time before the insurer begins covering crowns.

These factors impact how much you will pay for an implant with insurance. Just like I have mentioned above, the cost of the implantation process depends on the dentist and insurance plan you choose.