Choosing dental insurance that covers implants

Even if you brush, floss, and gargle regularly, tooth loss is still a possibility. You could, for example, lose a tooth from a sports injury or oral disease, and your dentist will tell you to get an implant. It's better than replacing natural teeth with dentures or bridges because letting you eat and speak with little or no discomfort.¹ However, the process of getting a dental implant is somewhat involved. It can also be costly, but the right dental insurance can make it more affordable. This article can help by telling you about:

• What dental implants are and how much they cost

• How to find coverage for dental implants

• How to choose the right dental insurance plan

Understanding dental implants

Dental implants support artificial teeth like crowns, bridges, and dentures, and are often used to replace missing teeth. They can restore someone’s ability to chew well, stabilize the jawbone to prevent further bone loss, improve their appearance, and improve their overall oral health.

These benefits can be significant, because poor oral health is correlated with increased rates of depression, anxiety, and self-esteem issues. 41% of working adults who rated their oral health as "fair" or "poor," for example, said they lacked self-confidence, 38% said they had low self-esteem, and 23% said they even avoided social situations.

However, dental implants are not inexpensive, because the process of creating and placing implants is exacting Titanium posts are surgically placed into the jawbone, allowing dentists to support artificial teeth. The implant acts as an artificial tooth root, and a small connector screws into the implant to extend beyond the gums. Finally, a porcelain crown, bridge, or denture that resembles a natural tooth is secured to the implant.

Things to consider if you need dental implants

First, bone grafts may be needed. Bone grafts replace missing, damaged, or lost bone in your jaw, and can better support dental implants. The majority of the healing process may take about a week, but it can take up to a year to completely heal.

Next, there are different types of implants to consider:

• Endosteal: The most common type of implant; it’s often screw-shaped, placed directly into the jawbone, and can hold one or more artificial teeth. These types of implants are more commonly covered by participating dental insurance than other types.

• Subperiosteal: Placed on top of the jawbone but beneath the gums; they may be used when there isn’t enough jawbone to support endosteal implants. They are more commonly covered by participating dental insurance compared to other types of implants.

• Zygomatic: Designed for patients with significant bone loss in the upper jaw, they can prevent the need for bone grafting by placing the implant into the cheekbone. This implant type is incredibly complex and rarely used.

Your provider can help you determine the best path forward and the treatment needed to install implants safely.

What to expect when getting dental implants

Generally speaking, there are three parts to the implant process, which can take many months to complete depending on the specific dental work that needs to be done and how fast your body heals.

Before the actual implant is placed, you'll need to receive an oral exam from a healthcare provider. They'll use x-rays to assess the health of your jawbone, whether a bone graft is required, and what type of implant may be best. If a bone graft is needed, restorative surgery will help reconstruct and regrow part of your jawbone. The healing process can take several months. At that point, you can proceed with the implant procedures. These are the three basic parts of the process:

1. The dentist surgically positions the implant into your jawbone and covers it for healing. It usually takes three to six months for bone to develop around the implant and anchor it in place.

2. Once the bone has grown around it, the dentist uncovers the implant and attaches the post, which the replacement tooth (or teeth) will eventually be mounted on. It may take several more months for the gums to heal.

3. Once the gums have healed, the dentist will attach the crown to the implant post.

Costs of dental implants

There are multiple factors that may influence the direct costs of dental implants, including the following:

• Pre-implant care needed: You will need to consult your dentist to identify the best plan of attack to receive your implant. The type and extent of oral x-rays used can impact your total cost.

• Potential need for bone grafts: More than half of patients need bone grafts before receiving implants, which may increase the cost significantly. These can cost anywhere from $300 to $4000.²

• Types of dental implants: Different types of implants can have varying costs. It’s often more cost-effective, for example, to receive endosteal implants than subperiosteal implants.³

• Your provider: Each dental practice has its own cost structure and rates for dental care.

• Your location: The cost of care tends to increase in locations with higher cost of living.

• Dental insurance: Some comprehensive dental insurance plans will cover a portion of the cost of implants. And, even if a procedure is not covered by your specific plan, using a network provider can make an implant more affordable because you’ll benefit from network discounts.

Understanding dental insurance plans

It’s important to understand how dental insurance works when choosing a plan that will work for you—including potentially covering implants. If you're shopping for a dental insurance plan online, there should be a link to the plan summary, which states whether dental implants are covered and, if so, to what extent. There are some other key terms to understand so you can budget accordingly:

• Deductible: The amount you have to pay out-of-pocket each year before your insurance starts covering costs.

• Premium: The monthly or annual fee you pay to maintain your dental insurance coverage. (if you have benefits through work, your employer may cover part or all of your insurance premiums as part of your compensation package.)

• Copay: The fixed amount you pay for a specific service at the time of treatment.

• Co-insurance: The percentage of costs you're responsible for after meeting your deductible. If insurance covers 80%, for example, you’ll need to pay the remaining 20%.

• Annual Maximum: The total amount your insurance will pay for dental care within a calendar year.

• Waiting Period: The time you must wait after enrolling before certain procedures are covered.

• In-Network: Dentists who have contracted with your insurance company to provide services at pre-negotiated rates.

• Out-of-Network: Dentists who haven't contracted with your insurance company, potentially resulting in higher out-of-pocket costs.

• Pre-Authorization: Insurance company approval is required before certain procedures to confirm coverage. Some dental plans may require pre-authorization while others might not.

Types of dental insurance plans

Unfortunately, there's no such thing as dental implant insurance; most dental insurance plans typically focus on essential preventative care. Implants are typically considered to be both major restorative care and cosmetics. As a result, many plans do not include any coverage for implants. This is particularly true of basic plans, which typically only provide coverage for routine treatment like exams, cleanings, and potentially basic fillings.

Some full-coverage plans, however, may cover at least portions of dental implants or partial dentures. While a full-coverage plan has higher premiums than a basic plan, it may also offer the following benefits:

• Typically lower out-of-pocket costs compared to basic plans.

• Provide full or partial coverage for a broader range of preventative procedures, including sealants or fluoride treatments.

• May cover additional procedures, including major restorative care or orthodontic treatment— meaning you may have at least a portion of your dental implants covered, along with other care for dentures, gum disease, and more.

Two common types of dental plans: Dental PPO and Dental HMO

Dental PPO plans allow you to choose virtually any authorized dentist and still receive benefits for covered care, and you don't need referrals to specialists. In-network providers will typically file claims for you, and there may not be a copay for regular preventive visits. Out-of-pocket costs will be higher when you see an out-of-network provider, and you may have to pay the bill and submit a claim to get reimbursed.

Dental HMO plans tend to be less expensive overall, and there may not be a deductible or an annual maximum. However, you're restricted to a much smaller number of in-network dentists, and you have to go through a Primary Dentist for all treatment and referrals when needed.

All plan types typically include waiting periods to receive non-preventative treatment. For example, you can usually have an oral exam and cleaning as soon as coverage starts, but you may have to wait a few months until procedures like cavity fillings are covered. If covered, major dental work, including implants, may require longer waiting periods of up to 12 months.

Coverage for dental implants

If you know you need dental insurance to cover the costs of dental implants, there are a few things to consider.

First, insurance plans are more likely to cover procedures deemed medically necessary, rather than just cosmetics. Dental implants are considered medically necessary in many situations, such as if the tooth was lost due to traumatic injury, treatment for other medical conditions (including chemotherapy), or if the patient is suffering from secondary health impacts like GERD or loss of function.

Second, it’s important to understand what level coverage you can receive. Many full-coverage plans may cover 40-50% of implant costs (after deductibles and up to the annual max) – but if you already have symptoms, make sure the plan you’re signing up for doesn’t limit coverage for a pre-existing condition.

Choosing the right dental plan for your needs

When choosing a dental plan, it’s important to know whether it covers the services you need (like implants) and whether you’ll be able to find network providers in your area. Of course, affordability is also a significant concern, but it’s important to consider overall dental insurance costs.

For example, one plan may only cost $15 a month but have drastically higher out-of-pocket costs, cover fewer services, and much lower annual maximums than a plan costing $45 a month. If you can comfortably afford the premium and believe you'll benefit from the increased coverage, you may be more likely to benefit from choosing the latter.

So if you believe you’ll need dental implants or other major restorative care, make sure you consider the following as you look at plans:

• Waiting periods for both minor and major restorative care.

• The percentage of coverage for specific conditions, procedures, and treatments.

• Policy factors like deductibles, copays, and annual maximums that could impact your how much you spend.

• Whether preexisting conditions would disqualify you from coverage of certain conditions.

How to buy full coverage dental insurance

If you’re interested in purchasing full coverage dental insurance to help make major dental procedures more affordable, take these steps:

• Check your workplace benefits: Many employers offer dental insurance benefits to employees. This is typically the best way to get coverage because it's easy to sign up, and you can take advantage of affordable group rates. However, if you already have a dental plan through work but it doesn't offer the coverage you need, you can look into getting a supplemental dental plan from another dental insurance provider.

• Consider your immediate needs: If workplace benefits aren’t an option and you need to purchase individual coverage, think about what you’re looking for in a policy. For example, if having a greater choice of dentists is important, consider a PPO plan. Want lower overall costs? Look into HMO plan options. And if you are concerned about paying for specific types of services or procedures, check the plan summary to make sure those items are covered.

• Compare quotes: Shop around to see what options are available to you, and directly from insurance providers to determine what makes sense for your budget. Make sure you review and understand the full details of each policy before making a decision. And again, if you want dental insurance that covers implants, check the plan summary to ensure coverage.

Tips to help make dental implants more affordable

Whether you’re looking for a new policy or not, you can use these strategies to help make dental implants more affordable and get the most out of your coverage:

• Check your medical insurance coverage, as some health insurance plans may cover medically necessary implants needed due to certain causes of tooth loss.

• If you are eligible for at least some coverage through multiple dental and/or health insurance policies, look into coordinating benefits and increasing your potential coverage around lifetime maximum limits.

• Time procedures strategically around annual maximum limits or deductibles of your dental coverage.

• If a procedure is denied (or you can’t get preapproval) talk to your dentist about how to appeal the denied claims.

• Work with providers to discuss discounts. And since providers have different rates, consider getting a second opinion and/or new quotes for at least some of the work needed.

• Leverage healthcare credit cards and savings accounts, including HSAs and FSAs, to make coverage more accessible.