Does Insurance Cover Dental Implants

Does Insurance Cover Dental Implants

You may need a dental implant if you have missing teeth or a missing tooth that needs to be replaced. There are many reasons why one would want to have a dental implant done as opposed to a dental bridge or partial dentures. Whether the tooth is missing and needs to be replaced due to an injury or from tooth decay issues, the first thing that most people are concerned about is if they can afford it. After most patients actually see the cost of dental implants, the next question is always, “does my insurance cover a dental implant?”

We wish that the answer to that question was as simple as a yes or a no. There are thousands of different dental insurance providers out there, and they all have numerous variations of plans. While most dental insurance providers consider dental implants to be of the cosmetic procedure category, they may still cover some of the cost. Medical insurance may also apply to dental implants because numerous problems that arise from having a missing tooth or teeth will be medically necessary to treat. Often times medical insurance providers see dental implants as an essential procedure for jaw restoration in order to be able to speak and eat properly. 

Determining Your Coverage

When either your dental or medical insurance plans do cover dental implants fully or partially, the amount of your coverage will depend on a number of different factors. Something that we see commonly is the missing tooth clause or coverage that is based on whether the tooth was lost before becoming enrolled or while you are enrolled in the plan. Some providers provide coverage in the plan for the implant restoration or the crown that is secured to the implant, but they do not cover the actual placement of the implant. Another consideration is that many dental insurance plans have an annual maximum dollar amount for coverage. The entire cost of the placement of a dental implant, installation of the abutment, and securing of the crown may exceed your plans maximum. Some plans also have a deductible or a dollar amount you must pay out of pocket towards medical or dental bills before they will begin coverage.

Often times, medical insurance will cover some aspects of the dental implant while dental insurance is willing to cover other aspects. The best thing you can do is contact your insurance provider for details regarding both your medical and your dental plans. During your consultation for a dental implant, we can help you determine what your plans are and are not going to help you with. Regardless of the verbiage that your policy contains in regards to dental implants and coverage, a claim can be submitted. In addition, an explanation of your dental circumstances and why a dental implant is needed can also be very helpful. An individual consultant from your insurance provider will review the claim with your documentation and may decide that you fit their criteria for more coverage then you may have expected. 

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