What You Need to Know About Dental Implants and Dental Insurance

You're having a tooth extracted, and you want to maintain your chewing ability or your smile.

While there are lots of treatment options, including dentures and bridges, you're considering implants.

As you consider your options, you also need to understand the costs associated with each of your treatment options.

Use this guide to understand the following questions:

• What are dental implants?
• Does dental insurance cover implants?
• Which insurers offer coverage for implants?
• What kind of coverage does Medicare offer for implants?
• What if my plan doesn’t offer coverage for implants?

What are dental implants?

Dental implants are fake teeth that are set directly into your mouth. If you have to have teeth removed or have lost teeth, implants are one treatment option to improve your smile and maintain your ability to chew food. You should always consult with a trusted dental care provider to receive specific advice on your treatment.

“Dental implants are man-made roots that are placed in the jawbone to help replace missing teeth. While missing teeth have been replaced for centuries, the modern dental implant has been around for about 55 years and is gaining more popularity as the Baby Boomer generation ages and the need to replace the weakened teeth becomes apparent. There is a push for accessible, affordable and permanent solutions,” says implantologist Dr. Jumoke Adedoyin.

Implants are a relatively new dental procedure. They are generally considered a better alternative to bridges and dentures because they tend to be more durable, don’t affect your other teeth, and feel more natural.

“When you lose a tooth, the surrounding teeth lose their orientation and the teeth become less stable. The adjacent teeth to a missing tooth will eventually begin moving to fill in the space, and the teeth above or below may begin to migrate toward the space. This shifting and misalignment of teeth can cause a cascade of expensive dental complications like temporomandibular joint (TMJ) disorder, tooth grinding, jawbone deterioration, tooth decay, and gum disease.

Implants are the only tooth replacement option that actually helps stimulate bone growth and prevent bone loss; they are stronger than your natural teeth, dentures, partials, or bridges. They last longer than these alternatives, and they don’t damage other teeth,” reports Dr. Charles Sutera, DMD, FAGD.

Implants tend to be more durable and usually require less maintenance than cheaper alternatives.

“Implants are the more permanent solution in the sense that the teeth don’t move around and that the bone does not resorb. Dentures need to be realigned every four to five years because the whole jawbone is shrinking. 

Also, implants are considered to be the better solution because it preserves your chewing function almost entirely as it should be. With a denture, you have to re-learn how to chew and it can greatly compromise your ability to digest food,” advises Dr. Mark Burhenne, DDS, AsktheDentist.com founder and number one bestselling author of The 8-Hour Sleep Paradox.

While implants have proven to be a better treatment than bridges and dentures and insurance companies are starting to offer coverage for implants, not all dental insurance plans cover them.

“Unfortunately, most dental insurance policies do not cover dental implants because most companies categorize these as a cosmetic procedure. Patients who have implants will disagree as in most times, it can be a life changing treatment option, affecting not only their self-confidence, but also their mental well-being and their ability to feel socially accepted,” says Adedoyin.

Even though insurance companies don’t always cover them, the demand for implants is increasing. This is good news because the increased demand has made implants more accessible.

“Because they are becoming the acceptable option in care, they are also readily available, not only at a specialized dentist’s office. They are being placed by general dentists with advanced training and are more and more affordable,” adds Adedoyin.

While still a lengthy and expensive process, not having to pay a specialist to perform the procedure can save you some money.

As you consult with your dentist on the best way to proceed with your care, keep in mind these cost trade-offs Sutera identifies:

“With proper care, dental implants can last a lifetime. This is not the case for dentures, bridges, or partials — driving up the cost of these alternatives over a lifetime,” he says.

Implants may have a high upfront cost, but it may be worth it to you in the long-run because you’ll avoid the maintenance costs associated with the alternatives.

While implants are a good treatment option, they aren’t always permanent. You should review the pros and cons of implants and alternatives with your dentist as you make a decision.

Burhenne identifies some issues that can arise with implants:

• “Implants can cause forms of gum disease known as peri-implant diseases. It is difficult to remove them, although I have seen some dentists unscrew them with ease. 
• Trauma to the face could mean that the implant pops out or breaks in the bone, which is another reason they can fail. 
• A further reason for failed dental implants is that the load is unevenly distributed. The load of the dental implant must be distributed evenly over multiple implant systems.
• Patients with reduced immune response (such as with autoimmune disease) or those who practice a very unhealthy lifestyle (smoking, poor nutrition, chronic disease) are more likely to reject the implants over time.”

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Does dental insurance cover implants?

The short answer is: it depends. 

First, it depends on the coverage you have.

“Most dental benefit programs will only reimburse a small portion of the cost of dental implants. Insurance companies will only reimburse if it’s a covered procedure within their contract. Read the fine print!” advises Dr. Larry Evola, lead dentist at Forestream Dental.

While implants are a better treatment for missing teeth, there are cheaper treatment alternatives including dentures, partials, and bridges. These are more commonly covered by dental insurance companies.

Does your dental plan cover implants? If your dental plan covers implants, you need to ask how much your plan will cover. 

“The best thing to do if a patient is really trying to rely on dental coverage and needs to know what they will cover in advance is to submit a 'pre-treatment determination.' The insurance company will give an estimate of what they would pay if the services were rendered, but even with a pre-determination they do not guarantee payment or coverage,” says Jamie Whalen-Murphy, office manager for Courtney Hain, DDS.

You should also check to see what waiting periods apply to implant coverage.

“For insurance companies that provide comprehensive coverage that includes dental implants, there is typically a required waiting period before the dental implant coverage can be active, so in the case of an immediate need, this policy serves very little benefit and only covers the cheapest replacement option to a missing tooth, which unfortunately is not the same as getting dental implants,” says Adedoyin.

You should also review your health plan to understand what your plan’s annual maximum benefit is. That’s the most your plan will pay towards your dental care for the year. 

“Keep in mind that you also have a yearly maximum that is usually met and maxed out with just one implant. An implant is typically done and several steps over the course of many months. You normally will get the implant done in one visit and come back after the bone has integrated after several months to get a crown placed on the top of the implant,” explains Kelly Hancock, RDH, and oral health writer for Toothbrush Life.

You and your dentist can use the timing of the implant procedures to your advantage.

“One smart tip to go about this would be to get the implant done at the end of one year and the crown done in the beginning of the next year. Having the two expensive procedures done on two separate years will help you maximize your insurance benefits,” suggests Hancock.

Unfortunately, there are some exceptions even if your plan covers implants.

“Many dental plans have what is called a 'missing tooth clause,' which says that they won't help cover the replacement of a tooth that was lost prior to the start of coverage,” says Whalen-Murphy.

While the kind of dental plan you have affects implant coverage, the reason for the implant has the most effect on whether or not insurance will cover it.

“The biggest determination on coverage is whether the service is strictly cosmetic in nature or medically needed for a variety of reasons” says Dr. Andrea Santo, DMD of Lakeview Dental of Coral Springs.

If an implant is for cosmetic reasons, you’ll probably be on your own. 

“Some individuals elect to improve their smiles via dental implants, which is very common and a popular route, but one should not expect notable coverage for instances like that. Other times, insurance may cover a portion of the cost of a replacement tooth, but not the cost of the implant or the procedure. It's really best to consult with your dentist and/or ask around for what your options are,” continues Santo.

However, if the implant is medically necessary or dentally necessary, you’ll likely have coverage if your insurance plan offers it.

“IF your dentist can prove the extraction, bone graft, and eventual implant treatment was necessary, at best, you'll only be reimbursed $1,500 (your maximum) for the treatment. If so, you've left yourself no money for preventive care for the year, so this is when an HSA/FSA is very helpful, since they help fill in the gaps that traditional health insurance leaves behind,” says Burhenne. 

You may even be able to get health insurance coverage for it.

“What many people may not realize is that dental implants and associated procedures may be considered medically necessary and can be covered by medical insurance because they prevent or restore bone loss of the jaw, which is known as disuse atrophy.

Dental implants may also be needed as a result of trauma or an accident, which also renders them medically necessary,” says Sutera.

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Which insurers offer coverage for implants?

Many dental insurers offer coverage for implants in at least one of their plans. A few examples include Guardian and Spirit. You can also use dental plan search engines like eHealth to compare dental plan costs and coverage across companies. 

While some insurance plans cover implants, keep in mind that the coverage may be limited and there may also be a waiting period. Some dental insurance carriers offer coverage for implants without a waiting period. As you consider your needs and your situation, think through the pros and cons of different plan models.

“Because of the cost, most dental insurance carriers have a 12-month waiting period on a major service. Other carriers don't have a waiting period, but these carriers may not pay as much towards the cost of the implant if the implant is needed in the first year. After a year, the plan pays more.

Then, there are plans that don't have a waiting period on a major service if the insured currently has dental insurance. However, they might have a lifetime dollar limit on dental implants.

This is reactionary and costs individuals far more in the long run. So, for seniors and families, my first recommendation is to purchase dental insurance long before you really need it. You may not need dental implants now, but who knows in the future,” warns John Barnes of My Family Life Insurance.

Understanding how the cost-shifting of different plan models works will help you choose a plan that best meets your needs.

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What kind of coverage does Medicare offer for implants?

What you can expect from Medicare varies based on which part of Medicare you chose.

“Regular Medicare doesn't cover most dental services, but Medicare Advantage plans often do with an 'additional coverage' option (and fee). Whether dental implants are covered will vary by provider, and you should check your plan description,” cautions Whalen-Murphy.

It’s always worth checking to see if care you need is covered. However, given how expensive dental implants are, it’s understandable that chances of coverage may be narrow.

“A Medicare Advantage plan is highly unlikely to approve coverage for dental implants. Those with Medicare coverage need to consider other options such as a stand-alone dental plan or paying out of pocket. If those options aren't enough, sometimes discount websites like Groupon have deals on dental services,” says Lindsay Engle, Elite Insurance Partners, LLC marketing manager.

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What if my plan doesn’t offer coverage for implants?

If you already need to get an implant and your dental insurance doesn’t cover it, you’ll want to explore other payment options. Paying a couple thousand dollars upfront isn’t feasible for everyone.

If you’ve got time on your side, you can plan ahead. Burhenne recommends taking the following steps to prepare:

• “Make sure to get a bone graft at the time of your extraction or else you risk not having enough bone to support the implant. 
• Reach out to your health insurance company NOW for a full copy of your plan. This will likely be dozens of pages and will include a multitude of exclusions and loopholes you will want to know about. 
• Start saving now. Utilize savings techniques, Bento dental, and HSA or FSA plans to help you afford it.”

If not, here are other payment options to consider:

• Health insurance
• Payment plans
• Loans and health care financing
• Treatment abroad
• Discounts and grants
• Health Savings Accounts and Flexible Spending Accounts

Health insurance

While health insurance won’t usually cover dental implants, there are some exceptions.

“Health insurance covers dental implants when they are medically necessary. Reviews and pre-authorizations need to be sent to medical insurance companies which take longer than dental to determine coverage,” reports Roberto Velasco, Uptown Cosmetic & Implant Dentistry.

Examples of when an implant would be medically necessary include the following:

“Health/Major Medical may reimburse in cases where implants are necessary due to an automobile accident, for example,” says Evola.

“Some medical insurance cover dental implants; however, only when used for fixation of maxillofacial prostheses after cancer reconstruction or severe trauma,” adds Adedoyin.

Keep in mind that coverage will vary based on your health insurance plan and how the health insurance company determines coverage.

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Payment plans

Remember how the implant process takes time? You can use this time to your advantage to break up the cost into more manageable chunks:

“Patients only pay for one stage at a time. Each stage is about three to four months apart. Not having to pay the entire cost at once does help a lot of people,” suggests Whalen-Murphy.

As you follow the advice of your dentist, you’ll want to plan your care with your budget in mind.

“The best way to defray the cost of a dental implant is to plan it, and stage it. The implant placement sometimes takes two or more appointments, and can last between three to eight months.  Using this time to your advantage to make payment arrangements for putting a tooth on that implant works well for most people,” advises Daniel Balaze, DMD, FAGD, and host of the Anything But Dentistry podcast.

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Loans and health care financing

Of course, you can go into debt for your implants.

“Additional options include getting a line of credit or personal loan from your bank or credit union. However, this may involve paying a high interest rate, so financial planning is warranted before going this route albeit you do get that beautiful smile, which gives you a boost of confidence and maybe you can go for that higher paying job,” explains Adedoyin.

Dental implants take several months to complete, so don’t count on a quick income boost right after. And, regardless of how your smile looks, it isn’t the only thing that affects a hiring decision.

Before you get a loan, evaluate your financial situation: 

• How much debt are you already in?
• Could you save enough to pay for it at each stage?
• What do your savings look like?

If you’re considering loans, you need to understand what the interest rates look like and figure out how quickly you could pay the loan off. How much more will you pay in interest for the implant? With interest you’ll spend more money on implants than they actually cost. The faster you can pay off the loan, the less interest you’ll pay.

In addition to personal loans from your bank or credit union, you could explore health care financing companies.

“There are health care financing companies like CareCredit that will allow monthly payments for implants. This is similar to applying for a car loan,” says Evola.

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Treatment abroad

There are well-trained dentists all over the world. With the rising health care costs in the United States, it’s becoming common for people to travel to other countries to receive care at lower costs. However, dental tourism is not without risk.

“I would never recommend that anyone have any surgery outside of their own country,” warns Balaze.

Balaze offers a several reasons for this:

“First is the possibility that there are language barriers and cultural barriers. It is of utmost importance to me that our patients understand all of the risks, benefits, and alternatives to the treatment they are about to have. I can't imagine that this is easy in a second language or in a place where customs and etiquette are different.

Second is the ease of having follow up care after the procedure. Especially in oral surgery and implant dentistry, the healing process can take months. If you begin to experience things that you're not comfortable with, how are you able to have your doctor evaluate what is going on?  What if the complications are serious?”

The third reason is that some dentists take advantage of people.

“There are wonderful, skilled, talented and passionate dentists anywhere you go in the world.  However, when a person tells me that they went to another country to have their dentistry completed in order to save money, I know that the chances of that dentistry being clinically acceptable are extremely low. It's unfortunate, but I think there are a large number of medical and dental tourism doctors taking advantage of people trying their best to improve their health.  Counterfeit and fraudulent treatment is not uncommon,” remarks Balaze.

This includes misrepresenting the quality of the implant, abutment, and crown installed. Whether or not you travel to get implants, you need to be sure that you trust the dentist placing the implant. 

“It is important to know that this can happen anywhere. There was an incident where an Ohio woman was having problems after having a crown placed — she had it analyzed and found that there was lead in it! It's very important to have a trusting relationship with your health care team, which is not an easy task when you are from another country,” Balaze concludes.

If you decide to travel abroad for treatment, you should review the Centers for Disease Control and Prevention’s (CDC) resources on medical tourism before you go. These will help you prepare, ask questions, identify risks, and understand what differences to anticipate.

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Discounts and grants

Some Section 501(c) organizations receive grants through the American Dental Association (ADA) to support their work to increase access to dental care. 

“There are other ways to pay for implant treatment; such as government grants that are handed out to non-profits, universities, and state agencies to help improve public health. These include the Samuel Harris Grant and the ADA Access to Care,” confirms Dr. Adedoyin.

These grants are usually geared for organizations that help increase access to dental care. However, you may be able to find other options with some research.

Alternatively, you can ask your dentist about pricing options or find an office that will offer a discount. Santo has a few suggestions on how to work with your dentist: 

“Patients can look for offices that offer discounted services, or look for options that provide a  bundled-package for multiple dental implants. These are becoming more common due to the rising costs of health care, but I would highly encourage you to perform your due diligence in verifying the practice's reputation and results. 

Additionally, you can ask the dentist for a discounted rate if the services are not covered by insurance. Many practices are open to discounts to help their patients and maintain their relationships.  Your dental office may extend a discount for the non-covered services or honor the insurance contracted rate, but it's highly dependent on your specific dental practice and circumstances for seeking the treatment.”

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Health Savings Accounts and Flexible Spending Accounts

If you have a health savings account, you can use those funds to pay for your medical expenses. These dollars are tax-free, which is another benefit.

“When dental insurance is not available to someone who needs dental implants, they may want to consider other financial spending and lending options to assist with the financial burden. Many working individuals have medical spending accounts through their employer allowing them to use pre-tax dollars for medical and dental procedures. Additionally, some lending companies offer interest-free financing,” says Dr. Robert D’Alfonso, DDS.

If you have a flexible spending account, you can plan to set aside pre-tax money throughout the year to pay for your implants.

“Also, using your Flexible Spending Account (FSA) to pay for your treatment is another way to fund your dental implants with pre-tax dollars. Once you pay for your dental implants with your FSA card, which is funded by your employer, you typically have 52 weeks to pay back your employer,” notes Dr. Adedoyin.

While dental implants are still expensive, paying the costs using tax-free dollars helps save you money overall.

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