Dental insurance helps reduce the cost of dental care.
However, it may not cover the costs of your dental implant as it is considered a cosmetic procedure and not a medical necessity.
If your plan covers the costs of your implants, it will only cover a portion (around 25% to 50%) of the treatment associated with the procedure. You’ll have to pay for the rest yourself, resulting in out-of-pocket expenses.
Below, we discuss dental implant insurance coverage, shedding light on the types and factors to consider when choosing insurance coverage for your implants.
Introduction to Dental Implant Insurance Coverage
Dental implants are artificial appliances designed to replace missing teeth. They consist of a screw-like device that is inserted into the jawbone to act as an anchor and an artificial tooth (aka crown) that is placed above it.
A metal connector or abutment is used to connect the artificial tooth to the dental implant, securing it in place. Most implants are made of titanium, allowing them to integrate with the bone without any side effects.
If you lose one or more teeth as a result of trauma, you may require a dental implant. However, getting one can be expensive. And that is why most people get dental implant insurance.
Dental implant insurance coverage helps subsidize the cost of dental implant procedures, making it more affordable. It also offers patients easy access to dental care without worrying about expensive fees. Unfortunately, not all dental insurance covers dental implants.
Basics of Dental Implant Insurance Coverage
What does dental implant insurance cover?
Dental implant insurance coverage depends on the insurance plan or provider. Since procedures like dental implants aren’t considered a medical necessity, your dental insurance may cover part of the cost.
For instance, tooth extraction (if the damaged tooth is still present) is often covered by insurance companies. Bone grafting, on the other hand, may not be covered by your dental insurance plan.
Your insurance plan may cover 50% of the cost of placing the implant, which is a major process. Similarly, your provider may also cover up to half of the cost associated with placing the crown.
Read your insurance policy to understand what it entails. You can also contact your dental insurance company or provider for specific information concerning your plan.
Common terms and definitions related to dental implant insurance
1. Deductibles
Deductibles are the amount you are required to pay before the insurance starts covering your treatment costs. They usually don’t apply to preventive treatments such as dental cleaning and diagnostic X-rays.
2. Copayment/coinsurance
Copayment is a flat fee the policyholder agrees to pay in advance for a covered service such as office visits, lab tests, prescription drugs, etc.
Coinsurance, on the other hand, is a percentage policyholders agree to pay for medical costs after meeting their deductible.
3. Yearly maximum
The yearly maximum is the most amount of money an insurance company will pay for your dental care in a year. Understanding your yearly maximum can prevent unexpected bills.
4. Waiting period
The waiting period, aka qualifying period, is the time a policy owner must wait before some of their coverage becomes active and usable. The waiting period for dental work is between 6, 12, or 24 months.
5. Preauthorization
Preauthorization is a process where the dentist seeks approval from an insurance company before commencing a particular treatment to ensure that the costs will be covered.
6. Premium
Premium is the amount you pay for your dental implant insurance each month or yearly. It helps keep your insurance active.
Navigating Dental Implant Insurance Coverage Options
Types of Dental Implant Insurance Plans
1. Preferred provider organization (PPO)
Like a health insurance PPO, these plans are offered by participating dentists, aka in-network providers, who accept subsidized fees for covered dental procedures.
While patients can choose dentists outside the network, visiting dentists within the network will result in the lowest out-of-pocket cost. The national average cost of dental coverage is around $350 to $500 annually.
2. Dental health maintenance organization (DHMO)
A DHMO consists of a group of dentists that accept the insurance plan, either for a set co-pay or zero fees. Unlike a PPO, seeing an out-of-network dentist may result in you paying the full treatment cost on your own.
The plan prioritizes regular dental checkups, cleanings, and preventive treatments as a way to help participants maintain their oral health.
Unfortunately, it has a smaller dentist network size compared to PPO. DHMO coverage costs around $200 annually (national average cost).
3. Discount or referral dental plan
While it’s not a dental implant insurance plan, discount dental plans help patients afford the cost of implants. With this plan, individuals are offered a discount on dental services from a designated network of dentists.
Unlike typical insurance, discount plans don’t pay for the cost of your treatment. Instead, participating dentists agree to reduce the cost of your dental implant treatment. Interested individuals are required to pay an annual membership fee to enjoy a dental discount plan.
4. Private dental insurance
Individuals are required to purchase private dental insurance personally and not via an employer. This type of insurance can be bought from a dental insurer or an insurance broker of your choice.
You have the freedom to select different plans that cover the dental treatment you desire, whether it is dental braces, dentures, or dental implants. Costs range from $20 to $50 per month.
Factors to consider when choosing dental implant insurance coverage
1. Premiums, deductibles, and limits
Before choosing a dental implant insurance coverage, look at the premiums.
Are the premiums high? Higher premiums translate to more extensive coverage and vice versa.
You should also look at the deductibles.
Deductibles are the amount you are required to pay before the insurance starts covering your treatment costs. The lower the deductibles, the higher the premiums.
Don’t forget the limits as well. Limits are the maximum amount your insurer will pay for your care in a year. It ranges from $1000 to $1500 annually.
2. Services covered by the plan
What procedure of the dental implant is covered by the plan you intend to choose? Is it the implant process, the abutment, or the crown?
Most dental plans cover all preventive services, 80% of minor restorative services, and 50% of major restorative procedures, including implants.
Read the insurance policy to find out the services covered by the plan. Or better still, reach out to the insurance company.
3. Waiting periods or qualifying period
You should also look at the qualifying period for the dental implant insurance coverage you intend to choose.
A qualifying period is the time a policyholder is expected to wait before they get full coverage for certain dental procedures.
Typically, preventive treatments have a shorter qualifying period, while others, like a dental implant, have a period of 3 months or more.
If the qualifying period of a particular coverage doesn’t meet your desired timeline, you can go for an alternative with a more suitable qualifying period.
Limitations and Considerations for Dental Implant Insurance Coverage
Exclusions and limitations of dental implant insurance
Dental implant insurance has some exclusions and limitations.
For instance, the insurance may cover some procedures associated with the implant, leaving you to settle the rest. This can result in a huge out-of-pocket cost.
In some cases, the insurance may not cover the dental implant procedure altogether since it’s not a medical necessity.
Additionally, dental insurance comes with annual maximum benefits, which may not cover the entire dental implant procedure, forcing holders to foot the remaining bills.
Preauthorization and preapproval processes for dental implant procedures
The preauthorization and preapproval process for dental implant procedures involves four stages. The first stage is where your dentist submits a plan that entails the cost of your treatment. Then, the insurance company reviews the plan to determine if the procedure is a medical necessity.
After reviewing the plan, the company will either deny or approve it. If approved, you’ll get an estimate on how much of your treatment will be covered and how much will be left for you to settle. If denied, you are allowed to appeal the decision.
Tips for Maximizing Dental Implant Insurance Coverage
Understanding cost breakdowns and out-of-pocket expenses
Understanding your cost breakdowns and out-of-pocket expenses is crucial for maximizing your insurance coverage.
Begin by scrutinizing your policy to determine what’s covered, what’s not, and the benefits provided.
Ask for a comprehensive cost breakdown from your insurance provider. It should include abutment, crown, implant, etc. It’s also crucial you understand your out-of-pocket expenses to budget effectively.
Utilizing supplemental insurance or discount plans for dental implants
Aside from your primary insurance, you can leverage supplemental insurance that offers coverage specifically for dental implants.
They help cover treatments your main insurance doesn’t cover. Dental discount plans are another option to consider. They help subsidize the fee of your dental implant procedure.
Conclusion
Dental insurance doesn’t cover dental implants 100%. Since the procedure isn’t a medical necessity, insurance may cover a portion of the cost, leaving the rest for patients.
Compare dental implant insurance coverage to see that which suits your needs. Check the qualifying period, premiums, and procedures covered. If you don’t want to consider insurance, you can leverage other financing options to reduce the costs of your dental implant.
FAQs
Does dental insurance cover implants?
Yes. However, this depends on your provider and the plan you choose. Your implants could be covered partially or in full.
What is the best dental insurance for implants?
According to Forbes Advisor’s analysis, Anthem Essential Choice PPO Silver is the best dental insurance for implants.
How much does most dental insurance pay for implants?
Dental insurance doesn’t cover implants completely. While some may not cover the procedure, others may cover 50% of the costs.
