Dental implants are essential for certain individuals, especially those who have missing teeth due to different circumstances. However, in many medical insurance policies, dental implants are not covered, claiming they are purely a cosmetic and not medically necessary. This can be challenging, especially if you want to improve your appearance and restore a natural, confident smile.

• Does health insurance cover motorcycle accident injuries?
• How much is Dental cleaning without insurance?
• Who pays Health insurance while on long-term disability?
• Does motorcycle insurance also cover medical bills?
• Does Homeowners Insurance Policy cover slab leak?

Nevertheless, there are some medical insurance plans capable of covering these costs, particularly if your dental implants are necessary due to a medical condition, accident, or disease. However, you must also note that even with such coverage, there are limits and it will depend on the specific insurance plan and provider. So, in this guide, we have clearly set out steps for you on how to get dental implants covered by your medical insurance, specific companies that do so in the USA, and other basic tips for a successful implant.

What are dental implants in medical insurance?

Dental implants are artificial tooth roots, typically made of titanium, that are surgically placed into the jawbone to replace missing teeth. Unlike dentures, implants are more permanent and are designed to match your tooth color and complement the shape of your existing teeth.

They provide better comfort and stability compared to dentures, enhance oral health by preserving the jawbone and preventing bone loss, and allow for easier eating and speaking. Additionally, implants are durable and can last many years with proper care, making them a cost-effective, long-term solution for tooth replacement.

How long do dental implants last?

Dental implants can last between 10 to 30 years with proper oral hygiene. While the implant root is designed to last the longest, the crown may need replacing after up to 15 years due to wear and tear.

Ideally, this means you could have your implants for the rest of your life, depending on when they were placed. Like natural teeth, artificial teeth (implants) require regular cleaning through brushing, flossing, and maintaining good oral hygiene.

It is always important for you to ask your medical personnel about the types of dental implants available and which one they will be installing in your gum.

Does my dental insurance cover implants?

Well, it greatly depends on your insurance policy, the limits, and extent of coverage. Medical insurance coverage varies by provider. Some plans offer extensive coverage without limitations, while others impose limits on certain costs.

Consequently, some policies may exclude dental implants, while others include them. In some instances, you might receive coverage for up to 50% of the costs for implants and crowns, particularly if the implants are needed due to tooth loss from an accident.

However, implants for cosmetic reasons may not be covered, and you would need to pay for those out of pocket. Therefore, it’s important to check with your insurance company to understand the specifics of your coverage and explore any potential options for reimbursement or partial coverage.

Why do some Dental insurance exclude implant coverage?

The primary reason is that they don’t view implants as a medically necessary procedure, but rather as a cosmetic surgery, and therefore don’t see a need to cover it. However, if implants are needed due to an accident, they are considered a medical necessity and may be covered.

Given the various circumstances that might necessitate dental implants, it’s crucial to check the details of your coverage with your insurer before proceeding. Understanding what is covered and what costs you will need to pay out of pocket will help you better prepare for the financial aspects of getting dental implants.

How do I know if my dental implants are covered by medical insurance?

To determine if dental implants are covered by your insurance, carefully review the policy details. Be sure to ask your insurer specific questions about the coverage, such as:

• Is there a maximum coverage limit on the plan?
• Are crowns and implants covered at the same percentage?
• What percentage of the procedure will the insurance cover?
• Does the coverage include the entire dental implant system, such as the implant, abutment, and crown?
• What is the waiting period for implant coverage?

This will help you understand whether your medical insurance policy will also cover dental implants. If it doesn’t, you may as well want to opt out or choose a convenient plan that covers your requirements.

How much do dental implants cost without insurance?

Without an appropriate insurance cover, dental implants can be costly due to the extensive preparation required before the final placement. Therefore, prices may vary for each procedure. For instance, a single dental implant typically costs between $1,500 and $3,000, while a full set of implants can range from $60,000 to $90,000.

Overall, the total cost for a single implant usually falls between $3,000 and $4,800. But even when you have full coverage for all the procedures, we recommend that you have some money on you to pay for out-of-pocket expenses when they arise.

How to get dental implants covered by medical insurance

Like we earlier said, dental implants are often considered a cosmetic procedure rather than a medical one. Therefore, getting a dental implants covered by medical insurance can be challenging. However, here are the tips to help you navigate these challenges and finally land your insurance cover:

1. Check your Policy: The first step is to review your medical insurance policy to see if it includes coverage for dental implants. Some plans may cover them if they’re deemed medically necessary, such as for reconstructive purposes after an accident or illness.

2. Consult your Dentist: Keep in touch with your dentist to help you determine if your implants might be covered under medical insurance and provide documentation of medical necessity.

3. Get a medical diagnosis: In case your dentist confirms that your dental implant is required due to a medical condition, then, you should have a medical diagnosis done to support this claim.

4. Submit a Claim: Work with your dentist and insurance provider to submit a claim. Make sure to include all relevant medical records and a letter of medical necessity.

After submitting your insurance claim, give time to your insurer to review and get back to you. However, note that sometimes insurance claims are rejected. So, in case it is denied, you can appeal the decision by providing additional documentation or ask your dentist to write a letter explaining why the implants are medically necessary. In worst case scenarios, you may want to consider alternative such as an appropriate dental discount plan to help with the cost.

Best Dental Insurance for Implants in the USA.

Insurance	Plan type	Waiting Period	Annual Maximum Benefit	Cost Range
Spirit Dental.	Pinnacle PPO	None	Upto $5000	$47.23 per month
Ameritas	PrimeStar® Total	None	$2500	NA
Guardian	NAP	12 months	$1000 – $2000	$30 – $70 per month
Cigna	Cigna Dental Vision Hearing 3500	None	$2,500	$62 average monthly premium

Editor’s Remarks

In conclusion, getting dental implants covered by medical insurance can be challenging due to the reasons we’ve explained throughout this blog. However, there still some insurance providers in the USA, Europe, and in other locations around the world that may provide coverage for teeth replacement depending on the conditions. So, we hope this guide has helped you answer your most burning questions. In case you still have more inquiries, feel free to leave them in the comment box below.

Frequently Asked Questions