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Are Dental Implants Covered By Insurance?

Posted July 01, 2024 in Dental Implants

an educational model of a dental implant with a happy smiling patient

Dental implant surgery is the optimal way to replace missing teeth and restore your mouth’s appearance and functionality, but it can be expensive. In this blog, we explore questions about dental implants and insurance.

6 Min Read:

Dental Implants: The Solution for Missing Teeth

Your normally confident smile doesn’t look the same if a tooth is gone. It can harm your overall wellness if you’re missing one or more teeth and are self-conscious about speaking, eating, or smiling. Not only does it usually affect your self-esteem, but it can also trigger long-term health problems. Missing teeth make you more susceptible to gum disease, which in turn can put you at risk for even more serious issues like heart disease and diabetes. It can also cause other teeth to move, creating spaces in your mouth and affecting your bite. Dental implant surgery is the optimal way to replace missing teeth and restore your mouth’s appearance and functionality, but it can be expensive. In this blog, we explore the sometimes complicated answers surrounding the question of insurance coverage for dental implants.

Are Dental Implants Covered by Insurance?

Typically, insurance does not cover dental implant surgery because this is considered a cosmetic procedure. However, just like with any type of insurance, there are exceptions. Dental implant surgery is often covered at least partially if the tooth or teeth in question were damaged due to an accident or injury, and the implant is considered a “medical necessity.”

It may take some time and research to discover if your insurance covers dental implants and to what extent, but it’s worthwhile to find out. To determine if your insurance covers dental implants, it’s essential to understand the process and different aspects of the treatment from start to finish.

The Dental Implant Process

When determining if your insurance covers dental implants, you may need to break down the treatment into the various procedures required during the implant process. These include:

Tooth Extraction

If you’re replacing a missing tooth or teeth, you may not need a tooth extraction. If you’re replacing a broken tooth, it must be removed before the implant is put in. Additionally, depending on how long the tooth has been missing, the surrounding teeth may have loosened and require removal as well.

Bone Grafting

If your tooth or teeth have been missing for a while, there’s a good chance you’ve experienced bone loss in your jaw. In this instance, you would need bone grafts to strengthen your jaw before the implant post can be placed to ensure your jaw can support the implant, keeping it stable and secure.

Implant Placement

Implant placement is the next step, where the metal post is implanted into your jaw. Once implanted, the post will need about three months to fuse to your jawbone in a process called osseointegration.

Crown Placement

After the implant post fuses to your jaw, it’s time to place the abutment and crown. The abutment is generally not covered by insurance, though a crown may be. Because a crown is also used to protect teeth from further decay, your insurance company may lump a dental implant crown in with a regular crown in terms of coverage.

The total cost of your dental implants doesn’t refer to just the implants themselves. There are several steps to go through before the actual implant procedure, and each step may or may not be covered by insurance. Some of the additional costs may include initial dental exams and consultations, x-rays, and anesthesia costs.

Questions to Ask Your Insurance Provider About Dental Implants

Because it may take several procedures to prepare your mouth for dental implants, some steps may be covered by insurance, and some may not. Some of the questions to ask your insurance provider before undergoing implant surgery include:

What Percentage of the Dental Implant Cost Will I Be Responsible For?

Depending on your insurance provider, type of coverage, and other factors affecting your need for implants, insurance may cover as little as 10% up to as much as 70% of the total cost of your implants.

How do Insurance Deductibles and Maximums Affect My Dental Implant Coverage?

Some insurance plans require you to meet an annual deductible before your coverage kicks in. If you have a $1,000 yearly deductible, that means you have to spend $1,000 out of pocket before your insurance pays for any procedure. Your insurance company may also cap your annual coverage, meaning they will only pay for procedures up to a certain amount. For example, if your insurance policy has a $7,000 yearly maximum, any costs over that amount will come out of your pocket.

Do I Need Pre-Approval Before Beginning Dental Implant Treatment?

Even if you have excellent dental insurance, checking to see if your provider requires pre-approval before beginning the dental implant process is always a good idea. Going through pre-approval ensures that your dental implant procedure is covered and to what degree. That way, you have peace of mind, so you’re not surprised when you receive your dentist’s bill.

What Are Pre-Existing Conditions That May Affect My Dental Implant Insurance Coverage?

Just like with medical insurance, your dental insurance may not cover specific procedures (like dental implants) if you have a pre-existing condition. For example, if you were already missing a tooth or teeth prior to obtaining your insurance, your dental implants may not be covered. However, it’s worth checking whether tooth extractions, bone grafts, or other pre-implant procedures are covered, as that may help offset the total cost.

What Are Dental Insurance Limitations?

Besides the fact that insurance companies frequently don’t cover dental implants because they’re not considered “medically necessary,” your insurance policy may also have other limitations you should be aware of. An example of this is a time limitation. Time limitations only allow you to get certain procedures once you’ve had your insurance policy for a certain amount of time. For instance, your insurance may only cover preventative care like checkups and cleanings for the first six months. After six months, your coverage may expand to include more in-depth procedures like fillings. And after a year, you may be eligible for coverage of more significant procedures—like implants.

If you are in dire need of dental implants but your insurance has a time limitation, some policies may waive the limitation if you were previously covered by another dental insurance plan.

Ready to Learn More About Dental Implants in Las Cruces?

If you’ve lived with one or more missing teeth for too long and are ready to restore beauty and function to your mouth, it’s time to explore dental implant surgery at Gentle Care Dentistry. To schedule a consultation with one of our expert dentists, call our office today at 575-524-3722 or complete the online contact form.