How to Get Dental Implants Covered by Insurance

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If you have recently lost any teeth, dental implants are an ideal solution that is the closest thing to having your natural teeth. However, implant dentistry can be expensive, so you may wonder – will your dental insurance cover implants?

Some dental insurance plans, and, in specific cases, some medical insurance plans, will cover dental implants. However, every dental insurance provider and plan varies, so the specific portions and amounts that are covered will vary, depending on individual cases.

Request your dental office to send your insurance company a preapproval or coverage request for your dental implant, so you know exactly how much is covered.

How Much Will It Cost?

Dental implants are more expensive than dentures, but costs vary due depending on your specific case. Implants have many benefits over dentures, including improving oral health and preventing bone loss in the jaw.

The cost will depend on the material used, and the number and location of the dental implants. The orthodontist’s experience and time required are factors, too, as well as any other related procedures deemed necessary.

Excluding x-rays and other supplementary procedures, a single dental implant averages about $1,500 to $3,000, plus around $1,500 for the replacement tooth. Porcelain is a more expensive material, but is extremely durable and natural-looking. A full set of upper implants can cost from $29,000 to $39,000, while a lower half set can cost from $25,000 to $31,000.

That being said, a dental insurance plan will reduce the amount you have to pay.

Related Supplementary Required Procedures

Be sure to consider any additional procedures that may be needed to be completed before implants are put in, as part of making sure the implant procedure is successful. Confirm with your insurance whether these additional procedures are covered.

Implants require the surrounding bone to be thick enough to heal and function properly; a bone graft may be needed to ensure the proper thickness. Sinus lifts are also sometimes needed in the upper molar area, to create enough room for the implants being put in, so they don’t encroach into the sinus space. Sometimes, a gum tissue graft may also be needed for implants.

Why Do I Need Dental Implants?

Your dentist may recommend dental implants to replace teeth lost due to periodontal or gum disease, or for teeth lost due to trauma or injury, where the tooth can’t be replanted. Root canals are successful 95% of the time, but they may fail, needing removal and replacement with an implant, too.

For a Healthy Jawbone and Good Oral Health

Leaving a hole in your mouth is not just a cosmetic issue, it can cause ongoing oral health problems, like other teeth shifting, a weak jaw, and bone loss.

Dental Insurance Plans

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Some insurance companies consider a dental implant procedure to be merely cosmetic, so don’t include them in their insurance plan. Some may be convinced to provide coverage, though, if your dental professional provides a written medical reason. Always check with your healthcare insurance provider to get any required paperwork before going to a consultation. Be sure to know the specifics of what procedures are covered and any limits or maximums.

Supplementary Procedures

Knowing the details of your plan will help you to make the most of what is covered. Even if dental implants are not explicitly covered, many stages of the process may be.

Consultation

Most private insurance companies will pay for a consultation, especially if it includes your regular checkup and cleaning at the same time.

X-rays

X-rays of your mouth and jaw will need to be completed to see if your jawbone is healthy and suitable for implants. Most insurance companies do include x-rays as a separate item for diagnostics, which you can claim.

Other Necessary Dental Care

If you have a dental health issue to be corrected first, including any filling, tooth extraction, root canal surgery or bone grafting to fix a jaw concern, these procedures may be covered as part of oral care, under regular dental work insurance. 

Your insurance may cover a crown, bridge, or denture that is supported by your new implants. With your dentist’s support, you may also be granted an allowance for the amount you would have been able to claim for a bridge or dentures, which you can instead apply to the dental implant surgery.

Dental Implant Insurance for Implant Procedure

If you do have coverage for implants, confirm limits, maximums, and restrictions, so you can budget as necessary. Usually, for example, providers won’t pay for implants if you were missing teeth before obtaining coverage.

Implants may be covered under injury or accidental trauma insurance plans, if applicable.

The entire process takes a while, but this can be a benefit. By starting at the end of the calendar or insurance year, and finishing in the new year, you can draw from both years’ maximum amounts.

If Your Dental Insurance Doesn't Cover Dental Implants

If your insurance policy considers implants to be a cosmetic procedure and doesn’t cover them, or only partially, there are other options. Different financing and payment options are possible, or medical insurance can also help.

Medical Insurance

If you have a health spending account, you can use this towards costs.

In certain situations, medical insurance may provide coverage, including where a lost tooth is creating medical complications, or for tooth loss due to oral cancer.

Compounding your coverage by claiming from both medical and dental insurance plans as much as possible will reduce what you have to pay.

Dental Care That Makes Insurance Easy

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Orchard Park Dental provides reliable, family-oriented care. We coordinate with your insurance and will bill directly to your insurance group or provider, for a hassle-free experience for you.

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