How to Get Dental Implants Covered by Insurance

It’s an unfortunate reality that tooth loss has become a common problem affecting a huge number of adults worldwide. However, dental implants have become a solution for replacing lost or decayed teeth. They not only restore your natural smile but also prevent bone loss. But, what stops many people from thinking about this healing treatment is the cost involved.

But did you know that you can get your dental implant costs significantly reduced or even covered by insurance?

Let’s explore how you can get your dental implants covered by insurance.

What Is a Dental Implant Procedure?

A dental implant procedure involves the surgical placement of artificial tooth roots, usually made of titanium, into your jawbone. Over time, these implants fuse with your bone, providing a sturdy base for supporting one or more artificial teeth or crowns. They may also require additional procedures such as bone grafting or tooth extraction. An implant feels and functions just like natural teeth, and with adequate care, it can last a lifetime.

How Much Does a Dental Implant Cost?

Dental implants cost varies significantly because of multiple factors, such as:

  • Location of the procedure
  • The dentist’s expertise
  • The specific conditions of the patient’s oral health

Generally, it includes the cost of implants, abutment placement, and artificial tooth placement or crown replacement. Basic procedures to complex procedures like sinus lifts or bone grafting may also influence the total dental expenses.

Insurance policies, coverage limitations, and out-of-pocket expenses also impact the overall cost. Some dental insurance providers cover implant treatment under major procedures, offering either full or partial coverage, substantially reducing out-of-pocket costs. However, to have an exact estimate of the dental implant cost, visiting a reputable dentist is advisable.

Does Dental Insurance Cover Implants?

Yes. However, your dental insurance will largely cover the implant cost depending on your dental plan, the insurance company’s dental policies, and your medical condition. As implants are classified as a major service, dental insurance providers typically offer some level of coverage as part of their major procedures provision.

How to Get Dental Implants Covered by Insurance

Step 1: Understand Your Dental Insurance Policy

Your path to cost-effective dental implants begins with a deep understanding of your dental insurance policy. Carefully review your policy form, paying particular mind to what dental procedures are covered and how your insurance defines basic services versus major procedures.

It is important to note that insurance policies vary significantly from one insurance carrier to another and even among different types of plans offered by the same insurance company.

Step 2: Have a Clear Conversation With Your Insurance Provider

Your insurance agent is an important ally in your journey to get dental implants covered by your insurance. Reach out to them to gain further understanding of your policy. An agent can help you understand common types of coverage, which might include preventive care like regular check-ups, restorative treatments including fillings and crowns, and, in some cases, major services like oral surgery and dental implants.

Step 3: Know the Extent of Dental Implant Coverage

After understanding your dental implant insurance policy and having open discussions with your insurance agent, you will be better equipped to comprehend how much your insurance may cover your dental implant procedure.

Many insurance providers consider implants a cosmetic procedure and might not cover them. However, an increasing number of insurance providers are recognizing the health benefits of implants for teeth and are starting to offer at least partial coverage.

Step 4: Know the Complexities of Dental Insurance Terms

Understanding insurance jargon such as annual maximums, pocket costs, and annual limits can be quite daunting. The annual maximum is the maximum amount your insurer will pay towards your dental costs in a year.

Pocket costs are your out-of-pocket expenses after insurance payments. Annual limits refer to the maximum amount that an insurance plan will pay for specific procedures within one year.

Step 5: Explore Dental Coverage Options and Cost Estimators

If your dental insurance does offer coverage for implants, use a cost estimator tool to calculate the likely costs you would incur after the insurance payments. Some insurance companies offer these tools, making it easier for policyholders to plan their dental expenses.

If you find out that your policy does not cover dental implants, explore a dental discount plan or alternative financing options.

Step 6: Coordinate With Your Dental Office for Billing and Payment Plans

Many dental offices can help patients with insurance dental claims and can provide information on monthly payments or payment plan options. When dealing with costly procedures such as dental implant surgery, having assistance from the dental office for the billing process can be invaluable.

How to Get Dental Implants Covered by Medical Insurance

Step 1: Consult Your Health Insurance Provider

It is essential to explore what your insurance provider covers and the types of plans they offer. Under certain circumstances, medical insurance can provide coverage for dental implants, particularly if tooth loss occurs due to an accident or disease, making it vital for you to inquire about such provisions in your health insurance policy.

Step 2: Secure a Medical Necessity Letter

As you plan to undergo an implant treatment, validating your medical condition can increase your coverage possibilities. Having your primary care dentist or doctor write a letter stating that the implants are a medical necessity based on your health condition can be beneficial, as it can improve your chances of pocket cost reduction from your insurance company.

Step 3: Work With an Insurance Agent

Getting a dental implant can be a costly procedure; hence, it’s essential to understand your coverage options. Get help from an experienced insurance agent who can guide you through the process of claiming the cost under your health insurance, ensuring that you get your maximum benefit from the insurance carrier.

Step 4: Pre-Existing Conditions and Implant Insurance

Various insurance providers have specific regulations associated with pre-existing conditions. Be aware of your health insurance aspects relating to pre-existing conditions, as they could have relevance based on your clinical history and need for dental implants.

Step 5: Comprehensive Dental Plans

Every insurance company has its distinct approach to dental coverage. Some insurance companies deliver comprehensive dental plans for individuals, offering coverage for implants, major procedures like root canals, and basic services like fillings, thus providing a balance between premium amounts and coverage limits for various dental procedures.

Dental Vs. Medical Insurance: The Difference Between Them

Dental and medical insurance are both types of coverage designed to mitigate the cost of health care, yet they operate differently. Medical insurance typically covers a range of health issues and preventative care, like physical exams and certain medications. However, dental insurance emphasizes preventive care treatments to promote oral health, including dental cleanings and check-ups. Dental insurance plans often categorize services into preventive, basic, and major procedures.

For instance, some dental insurance providers provide coverage for procedures such as root canals and dental implants. In contrast, medical insurance may cover certain surgical oral procedures and major medical complications. But it doesn’t generally cover routine dental care or cosmetic dental procedures. The key difference is primarily in the type of procedures and treatments they cover.

Contact Custom Periodontics & Implantology Today to Help You With Dental Implant Financing

Are you tired of hiding your smile because of missing teeth? At Custom Periodontics & Implantology at Fort Worth, we believe that everyone deserves a healthy and confident smile despite their budget limitations.

Dr. Shelby Nelson will guide you through the process, ensuring the finest implant procedures at the most cost-effective rates possible. We can assist you in understanding your dental implant cost with insurance to make your journey to a brilliant smile affordable.

Don’t postpone your happiness any longer. Contact us today, and let us help you restore your smile.