Dental implants are replacement tooth roots that are surgically implanted into the jawbone. They may make your smile more attractive, functional, and comfortable, but they can also be rather pricey.
The average cost of a single implant in the United States is about $4,000, and this does not include the crown, abutment, or other components that may be needed. So, will health insurance pay for dental implants?
The short answer is no, most health insurance plans do not cover dental implants. However, there may be some exceptions depending on your specific situation and the type of insurance you have.
In this article, we will explain how dental insurance works, why most plans do not cover implants, and what alternatives you may have to help you afford this procedure.
Understanding Dental Insurance Coverage
Dental insurance is a type of health insurance that covers some or all of the costs of dental care. Dental insurance plans vary widely in terms of what services they cover, how much they pay, and from whom you can get care. Here are some common features of dental insurance plans:
Types of Dental Insurance Plans
There are different types of dental insurance plans, such as preferred provider organization (PPO), health maintenance organization (HMO), indemnity, or discount plans. Each type has its own advantages and disadvantages in terms of network size, flexibility, cost-sharing, and premiums. You should compare different plans and choose the one that best suits your needs and budget.
Coverage for Basic Preventive Care vs. Restorative Treatments
Most dental insurance plans cover basic preventive care, such as exams, cleanings, x-rays, and fluoride treatments, at 100% or with minimal copayments. However, coverage for restorative treatments, such as fillings, crowns, bridges, root canals, and extractions, is usually limited to a percentage of the cost (usually 50% to 80%) and subject to an annual maximum (usually $1,000 to $2,000). This means that you will have to pay a significant portion of the cost for these services out of your own pocket.
Coverage for Cosmetic Procedures
Cosmetic procedures are those that improve the appearance of your teeth or smile but are not medically necessary for your oral health. Examples of cosmetic procedures include teeth whitening, veneers, bonding, and implants. Most dental insurance plans do not cover cosmetic procedures at all or only cover them under very specific circumstances.
Does Dental Insurance Cover Implants?
As mentioned above, most dental insurance plans do not cover cosmetic procedures such as implants. This is because implants are considered elective and not essential for your oral health.
However, there may be some cases where implants may be covered by dental insurance if they are deemed medically necessary. For example:
- If you have lost teeth due to an accident or injury: Some dental insurance plans may cover implants if you have lost one or more teeth due to an accident or injury that affected your mouth or jaw. You will need to provide documentation and proof of the incident and the resulting damage to your teeth.
- If you have a congenital defect or a medical condition that affects your teeth: Some dental insurance plans may cover implants if you have a congenital defect (such as ectodermal dysplasia) or a medical condition (such as oral cancer) that affects your teeth or jawbone. You will need to provide a diagnosis and treatment plan from your dentist or doctor.
- If you have severe bone loss or gum disease that prevents you from wearing dentures: Some dental insurance plans may cover implants if you have severe bone loss or gum disease that prevents you from wearing dentures or other removable prosthetics. You will need to show that implants are the only viable option to restore your oral function and quality of life.
Even if your dental insurance plan covers implants in these situations, you may still have to pay a large portion of the cost yourself. This is because most plans have a low annual maximum for restorative treatments and may only cover a percentage of the implant cost. You should check with your plan provider to find out the exact details of your coverage and benefits.
Alternatives for Covering Implants
If your dental insurance plan does not cover implants or only covers a small fraction of the cost, you may still have some alternatives to help you afford this procedure. Here are some possible options:
- Medical insurance coverage for oral cancer cases: If you need implants as part of your treatment for oral cancer, you may be able to get some coverage from your medical insurance plan. Medical insurance plans usually cover oral surgery and other services related to oral cancer diagnosis and treatment. However, coverage may vary depending on the type and stage of cancer, the type of implant procedure, and the provider network. You should consult with your doctor and your medical insurance provider to find out what is covered and what is not.
Options for financial assistance: If you cannot afford to pay for implants out of your own pocket, you may be able to get some financial assistance from various sources. For example, you may be able to apply for a low-interest or interest-free loan from a dental financing company, such as CareCredit or LendingClub. You may also be able to find a dental charity or organization that offers free or reduced-cost implants for low-income or uninsured patients, such as Dental Lifeline Network or Donated Dental Services. You may also be able to negotiate a payment plan or a discount with your dentist or implant specialist.
