You may have heard about dental implants. They're a popular option for people who are missing teeth because they offer several advantages over other tooth replacement options. However, this type of procedure is not cheap. So if you're considering dental implants, you're probably wondering how to pay for them.
It's a valid concern, and you're not alone. Many folks wonder, "Does health insurance cover dental implant surgery?" Keep reading to learn about different types of coverage and alternatives.
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Table Of Contents:
Understanding Dental Insurance for Dental Implants
Many dental insurance plans will cover a portion of the cost of dental implants. However, full coverage is unlikely. If you need an extraction, this procedure will be part of your dental implant treatment. Extractions are covered by most insurance companies.
A dental office will work directly with you and your dental insurance carrier. In some cases, your dental plan may cover up to 50 percent of "major" procedures like implants or crowns. However, it's always a good idea to check with your specific provider.
Coverage really depends on your specific plan. It's important to understand that most insurance providers will not cover dental implants if the sole reason is for cosmetic enhancement. Dental insurance usually covers things deemed medically necessary.
What About Medical Insurance?
You may be thinking that medical insurance could be an alternative to paying out-of-pocket for your dental implants. In some instances, your medical insurance plans may indeed cover part or all of the cost of dental implants, although it’s not common.
This is usually only if the implants are deemed medically necessary rather than cosmetic. For instance, if your need for dental implants results from an accident, medical insurance will likely apply. If the damage was a result of a tumor in the jaw that requires surgical removal, you’re also likely to have some coverage.
Some reasons medical insurance could cover dental implant surgery include:
- Jaw reconstruction after an injury or birth defect.
- Congenital anomalies affecting oral development.
- Implants necessary for facial prosthetics due to disease or injury.
- Teeth damaged or lost due to specific medical treatments.
However, each insurance company and plan differs on what they will or won't cover. Your oral surgeon will often know if the procedure might be covered by medical insurance and can help you apply. Sometimes, applying for implant coverage is as simple as including a letter of medical necessity.
Dental Implant Costs
Dental implant costs can vary. If you're missing multiple teeth, an implant-supported bridge will set you back $6,200, on average. Implants can be used as supports for full dentures, which cost $6,800, on average, according to Aspen Dental.
Forbes Health reports that a single tooth implant costs $3,100–$5,800. Full arch dental implants can cost $20,000–$45,000. Full mouth dental implants are at $60,000–$90,000, according to the American Dental Association.
This is just a range, though, because pricing also depends on location and expertise. This is why researching dental implant providers is essential to getting the best possible price.
Does Health Insurance Cover Dental Implant Surgery if the Implants are Necessary for Oral Function?
When someone's missing teeth significantly impact their ability to speak or chew properly, implants may be viewed as essential. They can restore their quality of life and overall health. But unfortunately, oral function is usually not a deciding factor for coverage.
While this is certainly a persuasive point to discuss with your medical insurance company, keep in mind that this argument often falls short. Function can often fall in the grey area between necessity and enhancement. However, it is worth exploring.
Factors that Could Influence Coverage
Besides necessity, here are several factors that may increase the likelihood that insurance will help you pay for your dental implants:
- Age: Some policies have varying degrees of coverage depending on your age bracket.
- Preexisting Conditions: Health problems can contribute to missing teeth and impact coverage.
- Policy Type: Standalone plans offer greater flexibility than supplemental options that pair with your health insurance. HMOs may also require you to stay within a specific network of dentists.
Does Dental Insurance Cover Bone Grafting for Dental Implants?
Bone grafting is a common procedure done before the implant placement procedure. It ensures the jaw is strong enough to support the implant. Unfortunately, dental insurance typically won’t cover bone grafting if it is being done just to support a dental implant.
However, if the reason for a bone graft is due to some other medical necessity, your medical insurance plan could provide some coverage. For instance, your plan might cover a bone graft that is reconstructing your jawbone after an injury or illness. You can get the exact costs of bone grafting from the dental practice performing your implants.
Also, contact your provider to find out if they'll cover any part of it. Most don't, but there are exceptions to every rule.
Understanding Dental Implant Procedures
It’s easier to talk about coverage if you have an understanding of dental implant procedures. The process for getting dental implants can involve multiple steps. It starts with a consultation, during which the dentist will use a 3D cone beam x-ray to take pictures of your jawbone structure, facial nerves, sinuses, and nasal cavity. This is essential for making sure that the placement of the implants does not damage any critical structures.
A custom-fit implant and crown that replicates your existing teeth is designed using sophisticated 3D software. Digital impressions will be taken, creating virtual models of your teeth. This is instead of the conventional impression technique that can be a bit messy and uncomfortable.
The first step may be a tooth extraction if there's an existing tooth in need of replacement. Your dentist or oral surgeon may also perform bone grafting during the same appointment to increase the thickness of the area where your implant will be. The bone grafting material is placed around your existing bone and covered with a membrane to guide bone growth and protection.
Typically, this graft integrates with your existing jaw bone over the next few months, providing an ideal base for placing the implant. After that, your doctor will surgically insert a metal post, called an abutment, into the bone.
This is a rather intensive step as the tissues in your gum must be opened up to gain access to the bone. A hole is drilled into the jawbone to insert the implant and sutured closed to begin the healing process. Your gums must heal around this post, which can take several months.
The next step, once the tissue and bone have fully healed and fused around the implant, is to connect an extension (or abutment) to the post. The abutment secures the crown that will sit on top. After this is attached, your gums will again need several weeks to heal.
This may take multiple visits to check the healing process before attaching the replacement tooth, or crown, to the post. The new tooth is then crafted to match the surrounding teeth. Once it is in place, the dental implant process is complete. You will now have a smile you can be proud of. Your dental implants will function just like normal teeth.
How to Maximize Dental Insurance for Dental Implant Procedures
Since getting your health insurance company to cover your implants completely is a long shot, here are some other things to think about when trying to maximize your coverage and get dental implants at a good price:
| Action | Details |
|---|
| Explore Dental Discount Plans | Many dental practices offer substantial discounts through dental plans you can sign up for that will save you money, especially if insurance doesn't cover everything. |
| Flexible Spending Account (FSA) | An FSA through your employer is funded with pre-tax dollars you contribute to specifically use toward medical and dental costs. These funds roll over from year to year, and you can start budgeting early in the year. However, some money may be forfeited if not all funds are used within a year. |
| Health Savings Account (HSA) | An HSA can be opened if you're enrolled in a high-deductible health plan. They're also funded with pre-tax money to be used toward health care expenses and can grow through interest earned. |
Dental implants can be pricey, even when insurance picks up a portion of the tab. Knowing what options exist for paying the difference could ease the financial strain. Instead of paying for your implants with a lump sum, you can make affordable monthly payments.
Alternatives to Dental Implants
Although implants are considered the most desirable form of tooth replacement, some situations call for alternative solutions. There are definitely several good reasons to think about other options.
Dental Bridge
This method offers a less invasive treatment that uses one or more false teeth to "bridge" the gap between existing teeth. You can select either a traditional fixed bridge that requires alteration of adjacent teeth or a removable bridge that can be easily detached for cleaning and maintenance.
Partial Dentures
This removable solution consists of a gum-colored plastic base fitted with one or more prosthetic teeth to fill the empty spaces in your mouth. You can remove the dentures for cleaning or sleeping. The fit is achieved by clasps or precision attachments.
This is where dental implants can play a crucial role in providing additional stability to partial dentures. Implants help give these types of dentures a more natural feel and functionality while ensuring a secure and stable fit. This is one area where exploring insurance coverage for both implants and dentures might be particularly helpful in reducing the cost overall.
FAQs About Does Health Insurance Cover Dental Implant Surgery?
How to Get Dental Implants Covered by Medical Insurance in the USA?
If you are in need of a dental implant procedure because of medical necessity, it’s best to speak with both your oral surgeon and your health insurance provider. These professionals can help determine coverage options and procedures.
How Much Does Most Dental Insurance Pay for Implants?
Insurance coverage can vary based on the plan. Typical coverage ranges from 10% to 50% of costs, although some plans offer no coverage. Before scheduling your surgery, verify your policy benefits and details.
Do Dental Implants Count as Medical Expenses?
Although considered cosmetic in many cases, dental implants can be categorized as medical expenses. If they’re deemed medically necessary for your condition, there's a chance that you'll get assistance.
A good place to find answers is the American Dental Association's "Dental Fees Results from the 2020 Survey of Dental Fees." The survey found that 76% of dentists charged between $1,000 and $5,000 per implant in 2020.
Why is a Bone Graft Not Covered by Insurance?
Typically, if the bone grafting procedure is done as preparation for a dental implant it isn't covered, as it’s not a medically necessary procedure in this case. Some exceptions could apply so check with your individual insurance plan to verify their rules.
In situations where bone grafts are considered a medically necessary step (like in cases of reconstruction), both medical insurance or dental insurance policies might offer coverage, albeit with varying degrees of benefit. The “National Trends in Dental Service Use, Costs, and Benefits and Barriers to Care Among Adults in the US Oral Health Surveillance System (2019)" report reveals an increasing demand for restorative dental procedures in recent years, with financial burdens being cited as one of the significant reasons hindering individuals from getting dental care, including potentially necessary bone grafts.
Conclusion
When people ask “Does health insurance cover dental implant surgery?," it boils down to whether the treatment is medically necessary, such as the result of an injury, rather than purely cosmetic. Even then, coverage varies significantly based on individual insurance plans and specific reasons for needing them.
It is imperative to check with both dental insurance and medical insurance carriers to explore your full range of options and maximize potential coverage. While not all aspects may be covered, many possibilities exist to mitigate the financial burden, including alternative dental solutions like bridges or partial dentures.
