There are endless possible answers to how much insurance pays for dental implants because many different variables go into the equations.
First, insurance plans work differently and have unique cost-sharing features.
Second, dental insurance plans frequently do not cover implants. However, various clauses limit how much they will pay when they do. For instance, waiting periods, annual maximums, and missing tooth exclusions factor in.
Third, medical insurance seldom covers dental implants. However, your plan might pay most expenses when medically necessary because waiting periods, annual maximums, and exclusions for pre-existing conditions do not apply.
Get a quick estimate of what dental implants cost with insurance.
How Much Dental Insurance Pays for Implants
There is no single correct answer to how much dental insurance pays for tooth implants (if covered) because each plan has unique features, and many patients run afoul of exclusions that limit benefits.
Learn how to get financial help with dental implants using your existing coverage as a bargaining tool. Providers might offer reduced prices to patients with the financial capacity to fund extensive treatment of other oral care.
Waiting periods are a huge factor in determining how much dental insurance might pay for tooth implants. Many plans exclude benefits during the first two years after the policy becomes effective.
Meanwhile, others limit claims.
Dental insurance with no waiting period for implants offers reduced benefits during the early years. For instance, one plan promotes this combination of coinsurance and a yearly maximum.
|Coinsurance *||Annual Max **|
* Coinsurance is the percentage of the allowed amount paid
** Annual maximum is the yearly limit paid by the plan (see below)
The annual maximum frequently limits how much dental insurance pays for implants. This feature places a ceiling on the benefits paid by the plan in one year.
The average annual maximum per person is only $1,500. Compare this benefit limit to the typical cost of a single tooth ($3,500) or full-mouth replacement ($35,000).
Spread treatment steps over multiple plan years if implants max out your dental insurance benefits. You cannot get permanent replacement teeth in a single day, and many service steps require significant healing time.
|Step||Months to Heal|
|Tooth Extractions||1 to 4|
|Bone Grafting||4 to 12|
|Body Placement||4 to 6|
|Abutment Insertion||1 to 2|
A missing tooth exclusion directly answers how much your dental insurance will pay towards implants: zero. The issuing company would deny your claim if you had this pre-existing condition before the coverage effective date.
Dental insurance without a missing tooth clause does not exist for individuals because the issuing companies do not want to trade hundreds in premiums for thousands in claims. Therefore, you might need an alternative.
Buying coverage at work is a possible solution, as issuing companies might wave the missing tooth exclusion to win business from a large organization with thousands of employees.
How Much Medical Insurance Pays for Implants
The answer to how much medical insurance pays for dental implants is binary: almost all or nothing.
- Almost all: medically necessary treatment
- Nothing: traditional oral care
Private health insurance pays almost all dental implant costs when medically necessary because, by law, these plans do not include an annual benefit maximum and must cover pre-existing conditions (missing teeth) with no waiting period.
Medically necessary services are “appropriate to the evaluation and treatment of a disease, condition, illness, or injury and are consistent with the applicable standard of care.”
Get dental implants covered by health insurance by submitting a letter of medical necessity to the carrier before beginning treatment. You will have to document in detail the qualifying reason. If approved, you might still have to self-pay for designated cost-sharing elements.
- Annual deductible
Public health insurance also pays most dental implant costs when medically necessary, with an added twist. Medicaid and Medicare sometimes include oral care benefits that fall outside of this category.
Medicaid covers dental implants when medically necessary uniformly across the country and acts as the public health insurance option for low-income families. Submit your letter documenting the disease or injury that the services will treat.
Dental services for adults covered by Medicaid that are not medically necessary vary from state to state. Depending on where you live, you could find significant financial support for other tooth replacement options such as dentures.
Dental implants for seniors paid by Medicare also fall into the medically necessary category, as this public health insurance program excludes coverage for most other types of oral care. Submit your letter documenting the disease or injury that the services will treat.
Medicare Advantage Plans (Part C) that cover dental implants follow the same rules, with a minor twist. Some include oral care benefits that fall outside of this category, giving seniors extra bargaining leverage when asking for a price break.