Dental Implant Insurance | How to Get Coverage for Dental Implants

Having dental implant insurance is the best way to reduce the amount you have to pay for replacing missing teeth with dental implants. But don't assume that if you have an otherwise good dental insurance plan, it will automatically include dental implant coverage. Always check carefully the policy for excluded treatment terms. If you are unsure, check with your insurance provider.

Dental implants provide excellent results for replacing missing teeth but it is a much more expensive treatment than other methods of tooth replacement. Most dental insurance providers typically cover none or less than 10 percent of the full treatment fees.

With a minimum cost of $1,500 (and $4,000 on average) many patients who have lost one or more teeth are unable to get the benefits of dental implants because they can't afford the cost.

In general, dental insurance policies do NOT cover dental implants, but several insurance providers offer coverage as supplement to your normal dental insurance although the extra premium you have to pay per year is much higher. Coverage under your medical plan may also be possible, depending on the plan and/or cause of tooth loss.

You must be aware that having a good dental insurance does not guarantee that you have any coverage for getting dental implant surgery. Various terms, exceptions and exclusions, may exist in your insurance policy that exclude dental implants either directly or indirectly. You may have insurance coverage only if it is stated clearly as a covered treatment. You should always check your insurance coverage before deciding dental implant surgery, unless you are prepared to cover the costs yourself.

The following terms may exclude dental implants from your insurance coverage:

• excluded treatment - often it will be directly stated in the policy that dental implants are not covered.
• existing conditions - many insurance policies will not cover you for the cost to treat conditions such as a missing tooth that were pre-existing at the time of signing your policy.
• cosmetic procedures exclusion - unfortunately dental implants are considered as a cosmetic procedure even though they provide functional benefits to the patient additional to the aesthetic ones. A common term in most dental insurance plans that cosmetic treatments are not covered might also exclude dental implants from insurance coverage.
• L.E.A.T. - another common term is that of the "least expensive alternative treatment". LEAT clause means that dental insurance will not pay you for the full cost of dental implants because there is an acceptable alternative treatment that is less expensive such as a bridge or a regular removable denture. Even if the provider accepts to cover the treatment, dental insurance coverage is normally not more than the cost of the alternative treatment.
• waiting time - when obtaining a new dental insurance you must usually wait for at least a year before having any serious dental work, or even more for expensive treatments.

If any of the above terms appears in your dental insurance policy, it is highly possible that you will have to pay the full cost of treatment on your own (or at least the bigger part of the cost).

It is very important to check your policy and find out if you actually have insurance coverage for dental implants before planning any surgery, unless you are able to pay for the full implant treatment cost from your own family budget.

In some case it is a mistake made by dentists and patients who do not submit claims for any of the dental implant treatment costs because they assume incorrectly that a dental insurance plan does not reimburse any costs at all, while there may be some benefit available.

• Partial coverage of restorative phase. Although your insurance policy might not cover dental implants, it might still possible to get some level of reimbursement for your expenses. Many insurance policies exclude the costs of the implant placement (surgical phase) but may cover some of the costs of the restorative phase as part of the plan's prosthetic coverage. In this case the dental insurance will provide reimbursement only for the tooth restoration (crown) in a manner similar to that in which natural teeth are restored.

• Partial coverage of preparation treatments. Some of the treatments that may be required prior to implant placement, such as tooth extractions, teeth cleaning, gum disease treatment are usualy covered as standard treatments. But other treaments as gum or bonus grafts, sinus lift etc are rarely covered.

• Specific case coverage. Some dental insurance providers will accept to cover the costs in certain cases only. The most usual case covered is that of a single implant used instead of a three-teeth bridge. The cost of the implant in this case is not significantly higher than the bridge, and the long term potential costs for the provider may be actually lower.
See also: Cost comparison - Dental Implant Crown vs Three-Unit Bridge

To receive the maximum reimbursement, the dentist must follow carefully the procedures outlined by the insurance provider. If the need for the implant restoration and the appropriateness of the case is made clear to the insurance provider's claims reviewer, many insurance companies will provide some benefit at least for the restorative part of treatment.

Several insurance providers offer coverage for dental implants as supplements to your normal dental insurance. The premium you have to pay is usually different for each individual based on factors such as the current status of dental and overall health, whether you are a smoker or the number of dental implants that you already have.

When you compare offers for dental implant insurance, costs must be compared carefully based on what is covered by each policy. The following factors should be considered:

• Even if you get insurance coverage, providers will rarely pay for the full cost of dental implants, but only for a certain percentage of the overall cost or for a fixed rate per treatment.
• Some plans provide reimbursement for both the surgical and the restorative parts of treatment, but only up to an annual or lifetime maximum.
• Other insurance plans have deductibles, a fixed amount that you have to pay yourself before they start covering your treatment costs.
• If you already have one or missing tooth before you purchase the insurance policy, you should check if there is any term that excludes coverage for treatments of pre-existing problems, otherwise your extra paid insurance will be useless for this case.
• Another consideration is the waiting time terms (how long you have to wait before starting any treatment). If you plan to start treatment as soon as possible, you should choose an insurance plan without any waiting time term or at least smaller than the usual one year requested by most policies.
• Check if the insurance company will cover the cost of re-treatment in case of implant failure, or if the prosthesis is damaged.
• Also, check if the policy would cover pre and post operative surgeries that maybe required (e.g. bone grafting), and any other dental problems that may occur due to any complication.

If your are being offered dental insurance through your employer that covers dental implants, you should definitely take advantage of it if you foresee that you will need such treatment soon. You will have to pay a much lower premium than if you purchased the additional insurance coverage on your own.

If you do not have a dental implant insurance or if you can't get one, there is another alternative to help you reduce the costs: dental discount plans.

Dental discount plans are not dental insurance. They work by offering a percentage based or flat rate discount on certain procedures. Many dental plans provide discount also for dental implants. They don't offer a high level of coverage but you don't have to pay the high premiums of dental insurance. Before you begin treatment, ask your dentist to obtain a pre-treatment estimate so that you know up front how much the dental plan will pay and how much you will be responsible for.

The disadvantage of dental discount plans is that you can get the discount from dentists partnering with the dental plan provider. While you can have a wide number of choices for a general dentist, it might be difficult to find an experienced dental implant dentist in your area who is a partner of the dental plan network. If the limited choices you might have are not a problem for you, dental discount plans can help reduce the amount you have to pay.