Dental Implants Costs with Insurance: Single-Tooth Full-Mouth

If you wonder how much dental implants cost with insurance, you have come to the right starting point.

The issuing company is the ultimate authority regarding the claims they will honor and the percentage of expenses they will cover. So they are your final destination.

But knowing the right questions to ask and the best moves to make before contacting your insurance company could make an enormous difference in your out-of-pocket spending.

Follow along as we break down the key issues worth understanding by comparing how various insurance plans work with a single tooth versus full-mouth restorations.

Then apply these lessons to establish a reliable budget and perhaps save some money.

How Much Single Tooth Implants Cost with Insurance

Your projected single tooth implant cost with insurance depends on the type of coverage you have, the expense-sharing features of your plan, and whether it covers any procedure steps.

Of course, these examples assume that your plan covers treatment – which is rarely the case. Free dental implant programs might prove more viable for the majority without coverage.

For illustration purposes, we compare the average retail price of $3,500 in the USA for a single implant, abutment, and crown and whittle it down to $3,000, $2,500, $1,900, $1,300, and $0.

Medicaid

Medicaid covers dental implants for adults when medically necessary (rare) under the health insurance component. However, it might pay only a tiny portion of expenses under the oral care element, which varies by state.

Therefore a single tooth out-of-pocket cost estimate with Medicaid breaks in two ways.

  1. $0 for medically necessary treatment because providers cannot balance bill
  2. $3,000 to $3,500 to replace teeth lost due to decay or gum disease because the least expensive treatment rule excludes most services

Medicare Advantage

Medicare covers dental implants for seniors enrolled in Advantage plans but not those with regular Parts A & B with traditional supplemental insurance (Medigap). However, the Advantage plans have minuscule annual limits to achieve affordable premiums.

Therefore a single tooth unreimbursed cost estimate with Medicare breaks in two ways.

  1. $3,500 for seniors with Parts A & B with no benefits
  2. $2,500 for seniors with Advantage plans with limited benefits
    1. $500 annual maximum
    1. 50% copayment for restorative care
    1. Discounts for using an in-network provider

Health Insurance

Health insurance covers dental implants when medically necessary (rare). Qualifying service is “appropriate to the evaluation and treatment of a disease, condition, illness, or injury and is consistent with the applicable standard of care.”

Once again, every healthcare plan has unique expense-sharing features. For illustration purposes, assume the following.

  1. Deductible: $1,500
  2. Coinsurance: 20%

Therefore a single tooth out-of-pocket cost estimate with health insurance is $1,900.

  1. Charge: $3,500
  2. Deductible: $1,500
  3. Coinsurance: $400

Dental Insurance

The cost of a single tooth implant with dental insurance depends on the exclusions in the policy, your choice of provider, and expense-sharing features.

Policy Exclusions

The missing tooth clause in many dental plans means that most patients have no coverage for any replacement teeth – including dentures. Plus, the minority extracting teeth first often find that their plan covers removable dentures but not the permanent crowns that snap onto the abutment.

Patients in this category pay the total retail price for a single tooth implant: $3,500

Network Providers

In-network dentists cannot charge more than the allowed amount when the dental insurance covers implants. Issuing companies negotiate a fixed fee schedule with providers typically lower than the retail price. Out-of-network offices do not agree with these discounted rates and charge whatever they like.

The total allowed charges for a single tooth implant could be very different.

  • In-network providers: $2,500
  • Out-of-network providers: $3,500

Expense Sharing

Every dental plan has unique expense-sharing features, so you will have to look up the details for your coverage. For illustration purposes, we will use these example numbers.

  • Annual deductible: $100
  • Yearly benefit maximum: $1,500
  • Copayment for restorative care: 50%

Your final out-of-pocket cost estimate for a single tooth implant breaks in two ways based on the network status of your provider.

In-NetworkOut-of-Network
Charges$3,500$3,500
Allowed Amount$2,500N/A
Deductible$100$100
Copayment($1,200)($1,500)
   
Patient Owes$1,300$2,000

How Much Full-Mouth Implants Cost with Insurance

The most critical factors determining the cost of full-mouth dental implants with insurance are different due to the hefty retail prices. Likewise, you will need to utilize unique strategies to minimize your expenditures

For illustration purposes, we compare the average retail price of $35,000 in the USA for the All on Four technique and whittle it down to $32,000, $22,000, and $8,500.

Annual Maximum

The annual maximum is the most critical factor determining how much it costs to get a full mouth of dental implants with insurance. This feature defines the limit your plan will pay each year.

Medical Maximum

Patients who can prove their dental implants are medically necessary pay the least out-of-pocket for a full-mouth restoration because medical insurance does not limit benefits with an annual maximum.

The patient responsibility is much smaller because only two expense-sharing features apply when covered by a healthcare plan.

  • Deductible: $1,500
  • Coinsurance (20%): $7,000
  • Total Owed: $8,500

Dental Maximum

Patients who cannot prove their tooth implants are medically necessary pay the most out-of-pocket for a full-mouth restoration because dental insurance typically limits benefits with an annual maximum.

Dental insurance with no annual maximums exists, but most patients do not have plans with this specific feature. Our example plan noted above is more typical and stops paying claims above $1,500, a tiny fraction of the retail price.

Spreading treatment over two years leads to only a modest cost reduction.

  • Upper & lower bridge in one year: $33,500 owed
  • Upper & lower bridge in two years: $32,000 owed

Meanwhile, combining treatment into one year leads to a more significant cost reduction. IRS-sponsored discounts on tax-deductible dental implant expenses grow with consolidation.

Health Savings Account

The cost of full-mouth dental implants is lowest with a High-Deductible Health Insurance Plan (HDHP) even when the procedure is not medically necessary because you can use your Health Savings Account (HSA) to pay the dentist.

An HSA is a tax-favored account connected to an HDHP.

You can use your HSA to pay for full-mouth dental implants even though the average retail price ($35,000) exceeds the annual contribution limits ($7,300 for a family). As long as you establish an account before incurring a qualifying expense, you can pay yourself back later using tax-favored dollars, provided you continue with an HDHP.

Consider this example for a hypothetical married couple (not retired) with a combined AGI of $100,000 who work in California.

Charges$35,000
Federal Income Tax (22%)($7,000)
FICA Tax (7.65%)($2,670)
State Tax (9.35)($3,260)
  
Net Cost$22,070

Frequently Asked Questions

Explore these frequently asked questions to learn more about the possible cost of dental implants with insurance. As always, there is no one correct answer, and the issuing company is the ultimate authority – not this article or any other you might find online.