How to Get Dental Implants Covered by Medical Insurance

Dental implants can be a great solution if you’re missing teeth. They look and feel like natural teeth, helping you smile confidently and eat comfortably. However, getting dental implants can be expensive, and many people wonder if their medical insurance will help cover the costs.

In this article, we will explore how you can get dental implants covered by medical insurance. We’ll explain the differences between dental and medical insurance, when your insurance might help, and the steps you can take to improve your chances of getting coverage. 

Medical vs. Dental Insurance

Medical and dental insurance often operate quite differently when it comes to coverage. Medical insurance typically covers treatments related to overall health, like surgeries, hospital stays, and preventive care.

On the other hand, dental insurance focuses specifically on oral health, covering routine check-ups, cleanings, fillings, and sometimes more extensive dental procedures like root canals.

However, dental insurance usually comes with lower annual maximums and may not cover cosmetic procedures like dental implants, which is why many people seek to have these costs covered by medical insurance instead.

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Understanding these differences is crucial, as it can help you navigate the insurance system more effectively and find ways to get the coverage you need for dental implants.

When Medical Insurance Might Cover Dental Implants

Medical insurance doesn’t typically cover dental procedures, but there are exceptions where dental implants are deemed medically necessary. Below are scenarios where medical insurance might cover dental implants:

1. Repairing Damage from Accidents or Trauma

Suppose you’ve experienced facial injuries from an accident—such as a car crash, fall, or sports injury—that resulted in the loss of teeth or damage to the jawbone. In that case, medical insurance may cover the cost of dental implants.

2. Addressing Congenital Conditions

Some individuals are born with conditions such as cleft palate, missing teeth, or underdeveloped jawbones. Medical insurance often covers treatments that involve dental implants as part of correcting these congenital defects, especially if they impair basic functions like chewing, speaking, or breathing.

3. Treating Oral Cancer or Other Serious Illnesses

Patients who have undergone treatments for oral cancer or other diseases that affect the jaw or oral cavity may require implants as part of their recovery process. In these cases, medical insurance can classify implants as necessary to restore the ability to eat, maintain nutrition, or prevent further complications.

4. Bone Deterioration (Osteonecrosis or Bone Atrophy)

Conditions like bone atrophy, which occurs when jawbone density decreases due to missing teeth, may qualify for medical insurance coverage. Implants might be approved if they are essential to preventing further bone loss or stabilizing adjacent teeth.

Essential Information Needed for Dental Insurance Verification

It’s important to review your specific insurance policy and check with your insurance provider to understand what is covered and what is not.

How to Get Dental Implants Covered by Medical Insurance

Getting dental implants covered by medical insurance can be a challenging process, but following these steps can improve your chances:

1. Review Your Policy: Carefully read through your insurance policy to see if it mentions coverage for dental implants. Look for any specific terms or conditions that might apply.
2. Contact Your Insurance Provider: Reach out to your insurance provider directly to inquire about coverage for dental implants. Ask about the criteria for medical necessity and what documentation is required.
3. Get a Medical Necessity Statement: If your dentist believes that dental implants are medically necessary, they can provide a statement or documentation to support this. This can be crucial in convincing your insurance provider to cover the procedure.
4. Pre-Authorization: Before undergoing the procedure, consider getting pre-authorization from your insurance company to ensure that the implants will be covered.
5. Preferred Providers: Check if your insurance plan has preferred providers or networks for dental procedures. Using a provider within the network can sometimes help with coverage.
6. Consider Dental-Specific Insurance: If your current health insurance doesn’t cover dental implants, you might want to look into dental-specific insurance plans or riders that offer coverage for such procedures.
7. Government Programs: In some regions, government health programs may offer limited coverage for dental implants, especially if they are medically necessary.
8. Payment Plans: If insurance coverage is not an option, many dental clinics offer payment plans that allow you to pay for the treatment in installments over time.

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By following these steps and staying persistent, you can increase your chances of getting dental implants covered by medical insurance.

Alternatives to Medical Insurance Coverage

If medical insurance does not cover your dental implants, there are several alternatives to consider:

1. Dental Insurance Plans: Some dental insurance plans may offer partial coverage for dental implants. It’s worth checking if any specialized dental plans could help offset the costs.
2. Payment Plans: Many dental clinics offer payment plans that allow you to pay for your dental implants in installments rather than all at once. This can make the cost more manageable over time.
3. Medical Credit Cards: Medical credit cards, like CareCredit, are designed specifically for healthcare expenses. These cards often come with promotional financing options, making it easier to pay for dental implants over time.
4. Dental Discount Plans: Dental discount plans are not insurance but provide discounts on various dental procedures, including implants. You pay an annual fee to join the plan and then receive reduced rates at participating dentists.
5. Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs): If you have an HSA or FSA, you can use these funds to pay for dental implants. These accounts allow you to save money pre-tax for medical and dental expenses.
6. Community Health Programs: Some community health programs and dental schools offer free or low-cost dental services. While you may need to meet certain eligibility criteria, these programs can be a valuable resource.
7. Non-Profit Organizations and Charities: Some non-profit organizations and charities provide financial assistance for dental care to those in need. Research local and national organizations that might offer grants or subsidies for dental implants.

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By exploring these alternatives, you can find ways to make dental implants more affordable and get the care you need without relying solely on medical insurance.

Factors That Affect the Amount of Coverage

The amount of coverage for dental implants under medical insurance depends on several factors. One key factor is the medical necessity of the procedure; implants are more likely to be covered if they address health issues such as bone loss, jaw dysfunction, or damage caused by accidents.

The specifics of your insurance plan also play a major role, as some plans offer broader coverage for oral surgeries while others are more restrictive. Proper documentation, including a clear diagnosis and supporting medical records, can influence approval.

Additionally, the use of correct medical billing codes and pre-authorization can significantly impact how much of the procedure is covered. Lastly, exclusions or annual coverage limits outlined in the policy may determine the final amount reimbursed.

How Much Do Dental Implants Cost Without Insurance?

The cost of dental implants without insurance can vary widely based on several factors, including the specific procedure, geographical location, and individual patient needs. Here’s a detailed breakdown of the expected costs:

• Dental Implant: Approximately $2,013 per implant.
• Abutment: A prefabricated abutment costs around $718.
• Crown: An implant-supported crown averages about $1,511.
• Extraction (if needed): Costs around $135.
• Bone Graft (if necessary): Typically costs about $552.

When adding these components together, the total cost for a single dental implant can reach approximately $4,929. This includes the implant itself, abutment, crown, and any necessary pre-procedure work like extractions or bone grafts.

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For multiple implants or more complex procedures (like an implant-supported bridge), costs can increase significantly—averaging around $6,200 for an implant-supported bridge and about $6,800 for full dentures supported by implants.

How Much Do Dental Implants Cost With Insurance?

The cost of dental implants with insurance can vary depending on your specific insurance plan and the extent of coverage it provides. On average, with insurance, the cost of an implant-supported porcelain crown ranges from $755 to $1,360, and a pre-fabricated abutment ranges from $358 to $645. This means the total cost, including the implant, abutment, and crown, can range from $2,113 to $3,805 after insurance coverage.

Alternatives to Dental Implants

There are several alternatives to dental implants for replacing missing teeth, each with its own advantages and considerations:

1. Dental Bridges: A fixed dental bridge uses the adjacent teeth as support for a false tooth (pontic) to fill the gap. This option is non-removable and can restore function and aesthetics.
2. Partial Dentures: These are removable prosthetics designed to replace one or more missing teeth. They are custom-fitted and can be taken out for cleaning.
3. Full Dentures: For those who have lost all teeth in an arch, full dentures provide a complete set of artificial teeth. They are removable and can restore both appearance and function.
4. Resin-Bonded Bridge (Maryland Bridge): This minimally invasive option involves bonding a false tooth to the adjacent teeth using a resin. It’s a good choice for replacing a single missing tooth.
5. Implant-Supported Dentures: These dentures are anchored by dental implants, providing more stability than traditional dentures. They can be a good option for those who need more support than regular dentures offer.

Each of these alternatives has its own set of pros and cons, so it’s important to discuss your options with your dentist to determine the best solution for your specific needs and circumstances.

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Conclusion

Getting dental implants covered by medical insurance can be a complicated process, but it’s not impossible. By understanding your insurance policy, working closely with your dentist, and providing thorough documentation, you can increase your chances of getting the coverage you need.

Don’t be discouraged if your first request is denied; knowing the appeal process and staying persistent can make a big difference. If medical insurance doesn’t cover your implants, explore other financing options to make the procedure more affordable.

Archer Finnegan

Archer Finnegan is a certified health insurance advisor with over 7 years of experience in the industry. Holding a CHIA (Certified Health Insurance Advisor) designation, Archer is passionate about helping people understand their coverage options. As an author on our Insurance Guy blog, Archer writes easy-to-understand articles that make health insurance simple and accessible for everyone.