It can be hard to know what is and isn’t covered by your dental insurance, especially when it comes to a procedure a bit out of the norm like dental implants. You may consider dental implants necessary because they are replacing your teeth, which you obviously need, but insurance companies may or may not consider it a medically necessary procedure. If you’re confused if they will be included in your coverage, read on to learn more!
Will My Insurance Cover Dental Implants?
Many basic plans do not cover implants or will only pay for part of the procedure like the crown, but not the implant post or abutment. They would much rather pay for preventive care like checkups, cleanings, and X-rays before serious issues develop that could require restoration of your teeth.
It is important to review your insurance policy. Look for a section titled “Major Services” or “Restorative Procedures.” Dental implants are usually classified under these categories.
The most direct and accurate method is to call your insurance provider. Ask questions like:
- “Do you cover implants?”
- “What parts of the implant process are covered?”
- “Are there pre-approval or documentation requirements?”
Know What May Be Required Before Getting Dental Implants
Often there is work that needs to be done prior to implants being placed, like tooth extraction, a bone graft, or a sinus lift. An extraction is dependent on whether the tooth being replaced is already missing or is partly damaged and needs to be taken out. If it’s necessary, it is covered by most insurance companies at least in part.
Bone graft is when healthy bone tissue taken from another part of your body is placed in the jawbone to ensure a strong, secure foundation for the implant. While this is a crucial part of the implant process, it may not be covered. Check with your provider to learn more.
A sinus lift is sometimes required prior to implant placement to increase bone volume in the upper jaw. While some plans may cover a portion of the cost, especially if it’s necessary for dental implants, others may not cover it at all. Again, contacting your provider directly or reviewing your policy will help you determine your coverage.
Maximize Your Benefits
Some helpful tips for getting the most out of your insurance include:
- Exploring in-network providers: Choosing a dentist who is in your provider’s network can unlock pre-negotiated rates they have with insurance companies, which can decrease your out-of-pocket expenses.
- Work on a timeline: Schedule any covered procedures within the same policy year. If your plan has an annual maximum amount that they will pay towards your dental care within a specific period, it’s a good idea to keep it all within that timeframe.
- Ask your dentist’s office to check: Most dental offices can verify your insurance benefits on your behalf and tell you what portion of the procedure is covered and what your out-of-pocket costs will be.
While the answer may seem complicated, your best bet to determine if your dental implants will be covered by your insurance company is to call your provider directly. It’s also important to check with your dentist to know if any additional procedures are needed before implants can be placed. Plus, they can work with you to get the most out of your benefits and provide you with all the upfront costs so you have a better idea of what you’re liable to pay.
About the Author
Dr. Vrajesh Shah is a graduate of the New York University College of Dentistry, where he also completed his specialty training in prosthodontics. Since then, he has completed countless hours of continuing education, including courses focused on sinus lifts, guided implant surgery, and bone grafting. He is a member of several professional organizations including the American Dental Association and the American Academy of Implant Dentistry. For more information about insurance coverage regarding dental implants, give our Edison office a call at (732) 943-1709 to schedule your appointment or visit our website.