Dental Insurance Covering Implants: Missing Tooth Clause

Many people shop for dental insurance covering implants just before or after having their teeth extracted, only to encounter a series of roadblocks.

Issuing companies erect barriers that protect them from the adverse selection: when people attempt to buy coverage for services they already know they need.

For example, you might find it impossible to buy homeowner’s insurance while wildfires rage nearby or immediately after your house burned down. 

Likewise, expect dental insurance companies to include language in the fine print that limits benefits for services already in your treatment plan – like implants.

Best Dental Implant Insurance

Patients often think that the best dental insurance alternative covering implants would do so without a missing tooth clause, waiting periods, or annual maximum. However, these expectations are unrealistic, as they invite adverse selection.

So, what should you do instead?

Financial assistance and grant programs hinge on your capacity to pay for other services such as fillings, root canals, extractions, cleanings, etc. Therefore, even if a new plan does not live up to your initial beliefs, buying a new policy could help in unexpected ways.

No Missing Tooth Clause

The best insurance alternative might cover dental implants without a missing tooth clause. However, the option does exist in the individual market because the issuing companies cannot earn a profit by marketing plans that honor enormous claims for pre-existing conditions.

The Affordable Care Act (ACA) requires health insurance to cover pre-existing conditions. Therefore, if you have a medically necessary reason (accident or illness-related), your medical plan might pay for selected dental implant expenses.

However, the ACA does not govern dental insurance.

The missing tooth exclusion clause allows the issuing companies to design dental plans at an affordable price for people looking to protect themselves from unforeseen future oral care needs. After all, that is the purpose of insurance.

No Waiting Period

The best dental implant insurance might also feature immediate coverage (no waiting periods). However, in addition to the missing tooth exclusions, the issuing companies could include graded benefits in the plan design.

In other words, plans without waiting periods will pay for implant-supported dentures or bridges only for those teeth still in your mouth at the coverage effective date. Plus, the fine print could impose early limitations on how much the policy pays for treatment, which eases gradually over time.

For example, a close inspection of the plan brochure might include a graded benefits schedule that initially throttles the percentage (copayment) or yearly total (annual maximum) paid towards any oral care treatments.

YearCopayment %Annual Max













No Annual Maximum

The best dental insurance covering implants might also feature no annual maximum, which would be critical given the expensive treatment options. A yearly maximum caps the benefits paid in twelve months.

However, dental plans without an annual maximum most likely will limit claims using other legal language found in the fine print in addition to the missing tooth exclusions.

  • Large copayments (60% to 75%) require patients to self-fund the majority of expenses, making treatment less likely to occur
  • An annual limit of one prosthetic appliance (surgical implant, abutment, and crown) excludes multi-teeth replacement

Supplemental Dental Insurance for Implants

Supplemental dental insurance covering implants is another alternative with features designed to combat adverse selection. Therefore, expect to find similar legal passages limiting benefits for pre-existing conditions: missing tooth exclusions, waiting periods, annual maximums, and graded benefits.

Supplemental means extra, and people typically buy this type of additional coverage to fill one of two possible gaps in their primary plan:

  • Does not honor claims for implants (surgery, abutment, and crown)
  • Does not pay for any oral care that is not medically necessary

Medicare Supplements

Supplemental dental insurance augments Medicare for senior citizens, primarily a health insurance plan that does not pay benefits for most forms of oral care (or implants) – unless medically necessary.

When it comes to Medicare supplements, the dental component addresses an enormous canyon – the absence of seniors’ benefits. Plus, the elderly often need extensive work done on their teeth and gums.

Therefore, expect the Medicare supplemental designs to work more like the primary forms of coverage noted above, which include the traditional limits on adverse selection:

  1. Missing tooth exclusions
  2. Waiting periods
  3. Annual maximums

Buying Supplemental Plans

Buying supplemental dental insurance to cover implants could make sense if your primary plan does not include this coverage. In this case, the additional policy increases oral care benefits overall and for specific treatments.

A monthly payment plan for implants can allow a supplemental dental policy to make financial sense as you must fund two sets of premiums while self-paying for any pre-existing conditions at the same time. Familiar language limiting adverse selection still applies.

  • Missing tooth exclusion
  • 24 month waiting period
  • Annual maximum ($1,200 to $1,800)

Final Thoughts

Buying dental implant insurance is unlikely to help patients who have already had their teeth extracted and could limit benefits for those that need to come out shortly.

Several policy design features discourage people with pre-existing conditions from signing up for individual plans: missing tooth clauses, waiting periods, annual maximum, and graded benefits.

Supplemental insurance has similar caveats.

However, buying a plan could still make economic sense because grant programs favor profitable patients: those with the financial capacity to pay for other services you might need. Dentists often offer free services as an enticement to individuals with poor oral health and the ability to fund treatment.