One of the most common questions people ask me about dental implants is not about the procedure, but if their insurance will cover it. As a general rule of thumb, most do not. So when preparing financially for an implant, plan on paying out-of-pocket.
Over the last several years, more dental insurances have begun to cover portions of dental implants but still only about 10-15% of insurances do. Below are some examples of what several of the patients that I have worked with over the past year have received from their insurance:
Example 1: The patient’s plan excluded coverage for implants so instead they paid based on the benefits for a three unit fixed partial denture. Paid: $1300
Example 2: Implants were covered at 50% after a $50 deductible up to a yearly maximum of $1500, which should have come out to about $1100. Unfortunately, this patient had very little of her yearly maximum left. Paid: $695
Example 3: Implants were covered at 50% after a $25 deductible up to a yearly maximum of $1500. Due to deductibles and a difference in the insurance’s usual and customary rates, the patient ended up getting less than 50%. Paid: $1085
Example 4: Even premium insurances don’t pay for the whole thing. This patient’s premium plan covered implants at 80% after a $200 deductible with no yearly maximum. Paid $1600
Other items to consider when using insurance for dental implants:
- There are pieces and parts that go into the cost of an implant that insurances won’t necessarily cover, like x-rays, surgical guides, and anesthesia. Also, they may only pay for one implant every 1 to 3 years, even if you are missing more than 1 tooth. Some will only allow 1 implant per lifetime.
- If you max out your plan on an implant, there may not be coverage for the crown or other yearly dental care.
- Watch out for a missing tooth clause. Just like the denial of pre-existing conditions in medical insurance, some dental insurances will deny coverage for an implant if the tooth was extracted or lost while you were covered under a different insurance.
Since dental implants are mostly an out-of-pocket expense, ask your oral surgeon about different payment plans and options. Remember, dental implants are the standard-of-care for the replacement of missing teeth and are a lifetime solution and investment. No dental insurance can say that.
Tags: insurance coverage for dental implants, insurance for dental implants