Does Dental Insurance Cover Implants?

by | Jul 30, 2022 | Patient Care

Navigating the world of insurance can be overwhelming when it comes to medical and dental care. Getting clear answers about what is covered and what is not can be confusing. This confusion continues to hold true when it comes to dental implants. Because many insurance companies consider dental implants to be cosmetic procedures, most people believe that getting insurance to cover implants is impossible.

But is it possible to get dental insurance to cover implants? This answer depends on many different factors, but it is possible to get your dental insurance, or even your medical insurance, to cover part or all of your dental implants.

Does health insurance cover dental?

Because not everyone has dental insurance, many often wonder if their health insurance will cover the cost of dental implants. The fact is, if you can prove that your need for dental implants is medically necessary, then many health insurance companies will cover the cost of your implants. There are many cases when dental implants are considered medically necessary including:

  • Implants are designed to prevent further bone atrophy caused by conditions such as osteoporosis, digestive disorders, or diabetes.
  • To restore chewing function after a serious injury to the jaw and teeth.
  • Replace teeth damaged by radiation treatments for cancer of the head, jawbone, and neck.
  • When your chewing is affected to the point it is worsening digestive disorders such as ulcerative colitis.
  • When certain medical conditions or medications caused dry mouth that ultimately led to tooth decay and loss.

If your need for dental implants falls under one of these categories, your oral surgeon may be able to apply to your health insurance carrier for dental implant coverage.

Types of dental coverage

The type of dental insurance you have can also affect your potential for coverage. In some cases, your medical coverage may include dental care. However, these plans may only cover preventive care and not major care. Stand-alone dental insurance plans often offer more flexibility regarding major dental care, such as dental implants. When considering dental implants, it is important to talk with your insurance carrier to find out what they cover.

What does your dental insurance cover?

Not every dental insurance plan is equal. While direct dental insurance plans can offer more flexibility and coverage options, not all insurance plans will cover everything. Here we look at some of the procedures dental insurance carriers may cover.

Preventive care

Preventive care, such as routine office visits and professional cleanings, is almost always covered by dental insurance plans. Routine preventive care helps to ensure your teeth and gums are healthy and reduces the chance of needing more expensive care, such as fillings, root canals, or other costly dental work. In the long run, preventive care saves you and your insurance money, so many plans cover these visits 100%.

Root canals

Root canals help to preserve the structure and functionality of badly damaged teeth. This helps to maintain efficient chewing ability, maintain bone structure and tooth alignment, and help to protect your other teeth from excessive strain.

Basic restorative care

Basic restorative care covers procedures such as fillings and crowns, to restore the structure and functionality of your tooth. This helps to reduce your risk of needing more major dental procedures down the road.

Oral surgery

Oral surgery is a major dental procedure covered by insurance in the cases of things like tooth extractions, tissue biopsies, drainage of bacterial infections of the mouth, and, in some cases, the placement of dental implants.

Prosthodontics

Prosthodontics is the area of dentistry that focus on the restoration of broken, decayed, and lost teeth. This can include anything from bridges and crowns to dentures and dental implants.

Periodontics

Periodontal disease, or gum disease, is the most common cause of tooth loss in America. Many insurance companies cover periodontic procedures, such as scaling, root planning, gum grafting, and periodontal surgery to restore oral health and reduce the risk of tooth decay and loss.

Orthodontics

Many insurance carriers will cover orthodontics when it is necessary for function. If purely cosmetic, not all policies will cover treatments such as aligners, braces, palatal expanders, and retainers. If necessary to adjust a problematic bite, most insurance plans will cover orthodontics.

Does dental insurance cover dental implants?

Whether dental insurance will cover dental implants depends on what your insurance coverage provides as well as what the reason is for your dental implants. In some cases, you may not be able to cover the implants themselves, but your insurance may cover the extractions to remove the damaged teeth, or the crowns used to attach to the dental implants. When considering dental implants, it is important to talk with your insurance provider and explore all options.

Why are tooth implants expensive?

Dental implants are a more costly tooth replacement alternative initially than other standard tooth replacement options. However, there are some things to consider. When you look at the alternatives, dental bridges or dentures, these options are typically cheaper at initial placement. However, they require special maintenance (specialized cleaners and adhesives for dentures) throughout their lifetime, adding additional costs. In addition, these restorative treatment options have a lifespan of five to 15 years, meaning they will need eventual replacement. Dental implants require no special treatment (you simply brush and care for them like your natural teeth) and typically last for your lifetime.

The cost of dental implants will also depend on your needs and health. In many cases, you may need additional procedures, such as bone grafts, to provide the jaw stabilization necessary to support the dental implants.

Dental Implant Cost with Insurance

When considering dental implants, it is important to work with your dental team and your insurance providers, both dental and medical. Depending on the reason for dental implants, portions may be covered by both your medical and dental insurance providers. While the complete cost may not be covered, it is possible to cover some of the procedure processes. Some important questions to ask your providers are:

  • When are dental implants covered?
  • What percentage of costs are covered?
  • What is your annual maximum out-of-pocket cost?
  • Will you need referrals from your healthcare provider or dentist?

Dental insurance can help you cover the cost of dental implants

While not all insurance providers will cover dental implants, there is the possibility. It all depends on the reasons behind your dental implants and the coverage you have available. At Soundview Family Dental, we understand how stressful dental procedures and dealing with insurance can be. Our team of professionals is here to help ensure you get the quality care you need and the coverage you are eligible for.

To learn more about dental implants and how they can work to help improve your smile, contact us today.

Eric Kitts

Eric Kitts

Eric Kitts has been practicing dentistry for over 20 years. Dr. Kitts is the owner and lead dentist at Soundview Family Dental in Edmonds, WA. He received his undergraduate degree from Washington State University and his DDS from the University of Washington School of Dentistry. Dr. Kitts treats each and every one of his patients with exceptional gentleness, care, integrity, and compassion, and this has made him one of Seattle Met’s top dentists for many years running. Dr. Kitts and his wife enjoy spending time with their two sons, skiing, camping, and cheering on the Seahawks.