Are Dental Implants Covered By Dental Insurance?

Are Dental Implants Covered By Dental Insurance?

Missing teeth can cause serious oral health complications. When teeth are lost or extracted, it’s important to replace them as soon as possible. There are a variety of tooth replacement solutions, but none compare to dental implants. Although dental implants tend to be more costly upfront than other options, they are the most durable and cost-efficient in the long run. And if you have the right dental insurance plan, the overall out-of-pocket cost could be even less.  Here’s a brief overview of dental implants and insurance coverage. 


What are dental implants? 

Dental implants are permanent replacements for missing teeth. Unlike other tooth replacement solutions, dental implants replace the entire tooth, from the root to the crown.  Implants are made of three parts:

  • The implant post – a titanium screw surgically inserted into the jawbone
  • The abutment – a piece that attaches to the post to extend it beyond the surface of the gum in order to attach the crown
  • The crown – the prosthetic tooth 

Dental implants look, feel, and function like natural teeth. They are the most durable, comfortable, and natural-looking tooth-replacement option available.  Dental implants are also the only solution for missing teeth that promotes bone health in the jaw. Dentures and other teeth replacements only replace the crowns. When the missing tooth root is not replaced, it results in jawbone atrophy and, eventually, facial collapse. By replacing the tooth root, the dental implant post helps to stimulate jawbone growth and maintain facial structure.  


Are dental implants covered by insurance?

The simple answer to the question “are dental implants covered by insurance?” is a very strong “it depends.” Like most dental insurance questions, the answer is almost always dependent on the individual’s insurance plan.  Some insurance companies will cover dental implants, and some won’t because they consider implants cosmetic rather than medically necessary.  Even in cases when the insurance company recognizes the medical benefits of replacing missing teeth with dental implants, they may not cover the implants in every situation. The only way to know for sure if your dental implants are covered is to call your insurance carrier and ask. Even if the answer is “yes,” be sure to get as much detail as possible so you’re not surprised by unexpected expenses.  


What you need to know about dental implants and dental insurance

Whether you’re looking for a new insurance company or planning to contact your current provider, the following information can help you ask the right questions about dental insurance coverage for dental implants. 


Out-of-network means more out-of-pocket

Some out-of-network practitioners will accept your insurance but the carrier will only cover a percentage of what they would for a dentist in their preferred provider network. If you don’t check on this ahead of time, you could be stuck with an unexpectedly large bill. You can usually clarify this by checking with your insurance company or asking the dentist’s office to provide you with your out-of-pocket cost based on your insurance plan. 


You may have to wait even if you’re insured

If you have a new insurance plan that does cover dental implants, you may still need to wait a year or more before your carrier is willing to cover them. If you’re switching insurance carriers for the main purpose of getting implants, be sure to ask about the waiting period.


Waiting longer might give you better coverage   

Complete coverage for dental implants would be considered extremely rare. The best dental implant coverage is usually at a rate of 50%. With some insurance carriers, you may be able to secure a higher level of coverage the longer you wait. They may, for example, cover 20% of your dental implant care if you get them in your first year with the company or 50% if you get them in your second year or beyond. 


Your benefits may be limited

Many insurance plans have annual limits, which means your insurance provider will only cover the cost of your dental care up to a certain amount in a year.  If this amount is less than the 50% of your implant care that you’re expecting them to pay, you’ll be stuck with the rest of the bill. It’s important to look into this prior to getting your dental implants so you can plan accordingly.  If necessary, it may be worthwhile to start your dental work at the end of one year and complete it at the beginning of the new year to split the coverage across two calendar years.  


Pre-existing conditions could exclude you from coverage

Every insurance company has their own rules about what constitutes a pre-existing condition. For example, a company may decide not to cover your dental implant care if you’re trying to replace a tooth extracted prior to the activation of your dental insurance plan.  Be sure to get clarity on the exact rules about pre-existing conditions from your provider.


Dental implant care involves a variety of cost factors that may or may not be covered

It’s important to understand the different cost factors involved with dental implant care so you understand which ones your carrier will or won’t cover under your plan. Depending on the scope of your treatment, the following may or may not apply:

  • Consultations
  • Anesthesia
  • Tooth extraction
  • Bone grafting
  • Implant placement
  • Crown placement


Even if your dental insurance won’t pay for the implants, you have options

If switching dental plans is not an option, and you are unable to pay the full cost of your dental implants upfront, ask your dentist about other options.  Many dental offices offer financing options, including CareCredit, a service that offers the option to pay for your dental work in installments. 


Ready to change your life with dental implants? Come see Dr. Hage today!

At Smile Designers, you’re in the hands of the best implant dentist in San Diego. Dr. Hage performs 100 procedures per month, with an extremely high success rate. Our in-house lab creates customized dental crowns from the highest quality materials, and Dr. Hage’s unparalleled commitment to patient comfort and satisfaction results in happy patients and radiant, healthy-looking smiles. Give us a call at (619)222-6000 to schedule your consultation with Dr. Hage today.