Many patients ask if their insurance covers dental implants. And some are misled into seeking in-network dentists with hopes of receiving benefits. Here are five facts you should know if you are considering dental implants and wondering if your insurance covers them:
- Coverage for dental implants: Majority of dental insurances do not provide any benefits for dental implants because they are considered elective. Yes, as far as they are concerned, you can get along with a partial denture to replace your teeth or do nothing at all.
- Choosing in-network or out-of-network providers: If your criteria for choosing providers is insurance, then you are in for a big surprise. Many patients make the mistake of seeking participating in-network dentists believing their treatment will cost less. The fact is going to a participating dentist will not make any significant difference in out-of-pocket expenses. And here is why: most dental insurances provide a maximum of $1000 or $1500 of benefit per individual per year. This allowance is usually exhausted by examinations, X-rays, teeth cleaning, and basic preventive procedures. Therefore, any additional costs for implants or crowns are not covered and become out-of-pocket expenses. Most dental insurances do not offer any benefits for dental implants and only small potential benefits for the prosthetic part. It is best to seek expert dentists based on their specialty and experience who can provide you with quality care and the results you expect. This involves an oral surgeon to place your implants and a prosthodontist or a very experienced general dentist to restore them.
- Coverage for the crown: The crown is separate from the dental implant and maybe a covered benefit under some insurances. But here is the problem: dentists who participate with insurance companies must accept discounted fees for their work. This lower reimbursement forces them to use lower quality laboratories for the fabrication of the custom abutment (the extension that sits on the implant and supports the crown) and the crown itself. Furthermore, some dentists save additional money by using non-customized abutments for the crowns which often result in poor fit, compromised cosmetic results, and hygiene problems. Poor materials, poor designs, and poor fitting components all lead to complications and failures.
- Misleading information from insurance companies: Many insurance companies mislead their subscribers by referring them to their participating dentists even though dental implants are not considered covered benefits. What insurance companies don’t tell their subscribers, which they clearly should, is: “Sorry. Dental implants are not covered procedures so we recommend you to speak to your friends, do an online search, and read patient reviews to find the best quality specialists for your dental implant treatment.”
- Medical insurance for dental implants: Medical insurances may consider dental implants or related bone grafting procedures if the loss of teeth was resulted from trauma. A pre-authorization is often necessary.
Here is the bottom line: when it comes to getting quality dental implant treatment that looks great, feels great, and lasts a lifetime, don’t count on your dental insurance. Instead seek the best oral surgeon and a restorative dentist who can masterfully provide you with great quality of work you expect. Ask them for a payment plan that makes the ideal treatments possible. Yes, it will cost you more, but in the long run you will save money by doing it right the first time.