Healthcare Flexible Spending Accounts (FSAs) are a popular employee benefit that allows individuals to set aside pretax money for eligible medical expenses.
While many people are familiar with using FSA funds for routine dental care, such as cleanings and fillings, they might be unaware of hidden ways to maximize benefits.
The short answer is yes, FSAs can be used to cover the cost of dental implants.
The better answer is you make the most from an FSA by employing different strategies based on whether you are replacing a single tooth or your whole mouth.
You will be amazed at how an FSA can make treatment more affordable!
FSA for Single-Tooth Implants
First, we examine how to use a Flexible Spending Account (FSA) for single-tooth implants to maximize the benefits, making them more affordable in ways you probably never anticipated.
An FSA is a legitimate government grant for dental implants, provided you learn how to capitalize on this seemingly mundane IRS-sanctioned employee benefit.
The alter ego of the use-it-or-lose-it rule turns an FSA for single-tooth dental implants into an interest-free financing program for patients with bad credit or no history whatsoever. The IRS requires employers to reimburse eligible expenses immediately, even if you have no money in the account yet.
Single-tooth implant financing with bad credit is viable by using your FSA. Patients with adverse history appearing on the consumer report (delinquencies, charge-offs, repossessions, etc.) benefit from this little-known wrinkle.
Under IRS Section 125 rules, employers cannot deny participation based on credit history or score. They must accept all employees choosing to partake while meeting non-discriminatory requirements.
No Credit Check
No credit check dental financing for single-tooth implants is feasible via your FSA. This obscure feature can benefit patients without borrowing or payment history on their consumer reports.
Under IRS Section 125 rules, employers cannot pull a copy of your credit report or consider your FICO or Vantage score. They must accept all employees choosing to participate, regardless of their borrowing history.
Interest-free medical loans for single-tooth dental implants are also feasible using your FSA to pay for eligible expenses. Patients having difficulty affording the procedure find this benefit most appealing.
Under IRS Section 125 rules, employers cannot charge interest under the program. Better yet, you have up to 52 weeks to repay the loan using pretax payroll contributions, reducing your exposure to three possible taxes.
The grace period makes using your FSA to pay for single-tooth implants safer from the use-it-or-lose-it provision. Many employers offer a grace period or a carryover option allowing employees to use their funds beyond the plan year’s end.
Single-tooth implant costs without insurance average $3,500, just a little over the FSA contribution limit for an individual. Elect to contribute the total amount during the open enrollment and schedule your first treatment step at the beginning of the plan year.
The grace period protects you in case treatment spans more than twelve months, which is possible given the healing time needed between each step (see below).
FSA for Full-Mouth Implants
Next, we explore using a Flexible Spending Account and maximizing the benefits of full-mouth dental implants, a far more expensive procedure. Contribution limits restrict the benefits, but intelligent planning can offset the drawbacks.
The contribution limit makes it less desirable to use an FSA to pay for full-mouth dental implants, which cost at least $35,000 and often range higher.
The annual limit changes yearly, but the best case is that an FSA might cover only 10% or 20% of full-mouth replacement costs without insurance.
- 10%: one person contributes the maximum ($3,050 at the publication date)
- 20%: your spouse contributes the maximum through their employer
Using an HSA to pay for full-mouth dental implants works much better, even though a Health Savings Account also has annual contribution limits. Unlike an FSA, you can reimburse yourself for eligible expenses in future years.
The healing time between the possible treatment steps can overcome the annual contribution limit issue when using an FSA to pay for full-mouth dental implants. With crafty planning, you could expand the 20% coverage level to 60%.
Your prosthodontist cannot install a full-mouth replacement in one day because you must wait for your jaw and gums to heal after each step and for osteointegration to complete. A precisely timed treatment plan taking 25 months could span three FSA plan years, tripling the benefits!
|Step||Months to Heal|
|Tooth Extractions||1 to 4|
|Bone Grafting||4 to 12|
|Body Placement||4 to 6|
|Abutment Insertion||1 to 3|
When FSA Covers Dental Implants
Finally, we address when a Flexible Spending Account covers dental implants, helping you maximize benefits by dispelling myths that might discourage you from making contributions and filing claims.
Your FSA should cover dental implants when the plan administrator classifies the treatment as medically necessary. You might find varying definitions for this term, so do not allow these differences to dissuade you from contributing the maximum and filing a claim.
- Medically necessary dental implants for health insurance adhere to the highest standard: appropriate to the evaluation and treatment of a disease, condition, illness, or injury consistent with the applicable standard of care.
- Medically necessary dental implants for Flexible Spending Accounts have a more lenient standard: you lost teeth due to injury or periodontal disease, and the replacement teeth are needed for your health and well-being.
- Medically necessary tooth implants with dental insurance have standards similar to an FSA but often exclude benefits for this particular procedure due to the expense compared to dentures.
In other words, just because your medical or dental insurance company rejected your claim does not mean that your FSA administrator will, too. They all follow different rules.
An FSA does not cover dental implants when the plan administrator deems the procedure cosmetic: altering healthy tissue to improve appearance. You might encounter this problem if you replace existing teeth because they are worn, discolored, or misshaped.
You do not want to contribute the annual maximum and then lose the money due to a denied claim. Therefore, take several proactive steps to overcome the cosmetic exclusion rule.
- Visit your dentist to get a treatment plan and cost estimate and document the medically necessary reason you need to replace your teeth.
- Submit the documentation to your FSA administrator for preapproval.
- File the preapproval from the plan administrator in a safe place for later use.
- Choose the appropriate contribution amount during open enrollment based on the cost estimate provided by the prosthodontist.
- Schedule the initial procedure during the first month of the plan year to maximize the benefits.
- Take advantage of the interest-free financing
- Constrain single-tooth expenses into one year
- Spread full-mouth expenses over several years
- Submit a claim for reimbursement to your FSA administrator, including all necessary documentation, such as the itemized receipt and proof of preapproval.