Planning to get a dental implant? Though it’s one of the more sophisticated methods of restoring a missing tooth, implants can also be rather costly and crucially difficult for dental insurance to cover. Surprisingly, ‘implant-friendly’ policies tend to be more elusive than expected. Even many policies that do seem to cover implants refuse covering those which are cosmetically motivated in nature.
Here is a complete dental insurance selection guide on how to easily and seamlessly claim for implants so that you can smile confidently as soon as possible.
Mark Your Notes
- Dental implants are sophisticated devices that substitute the place of a missing tooth.
- Your estimated costs of dental implants should go down by between 10% and 50% with the use of insurance, assuming the deductible has already been accounted for.
- Not every dental insurance policy includes implants, and those that do tend to have some constraints.
- While assessing dental insurance policies that cover implants, It is crucial to evaluate such criteria as maximum availabile coverage, deductibles, waiting periods, percentage of coverage for the implant, and coverage percentage for the crown.
- If you find out that implants are not right for you, bridges and dentures are suitable alternatives.
Are Dental Implants Part of My Insurance Policy?
Dental implants are not guaranteed to be reimbursed by your insurance provider. Most plans will gladly cover the expenses that stem from an accident but will not cover costs that are deemed cosmetic.
If your plan does reimburse some of your implants costs, it will probably reimburse only a portion, say between 25% and 50%, of the total expenses. And you may need to wait for a period of six months, a year, or even longer to get maximum reimbursement.
What Are Dental Implants?
A dental implant refers to a medical apparatus that is placed within the jaw surgically, and it serves as a replacement for a lost tooth. An entire dental implant system can be broken down into three parts.
- The implant body. This is a screw-like device that is implanted into the jaws bone instead of the tooth root.
- The crown. The artificial tooth that is affixed to the abutment.
- The abutment. This is one that is fixed to the implant body, and it extends upward through the gums and serves to support a dental crown.
Lack of Coverage Issues
Dental insurance providers typically do not cover dental implants because the procedure is deemed cosmetic rather than medically necessary. Some policies might also restrict coverage if you were missing a tooth prior to the commencement of the policy.
Different aspects of the procedure may also be omitted or not fully covered.
- Extraction of a tooth: Many insurance companies cover this basic procedure, especially if there is a damaged tooth that needs to be extracted before the surgical implant can be put into place.
- Bone grafting: Reinforcement of the jaw bone is a grafting procedure that some patients are required to ensure that the implant is properly secured. It may not be covered.
- Implant placement: This procedure is the most integral and often referred to as a ‘major’ procedure due to its high cost. Patients are often covered for up to 50% of the cost, but many plans are less supportive.
- Crown placement: This crown acts as an ceiling cap for the implant and is an Artificial tooth. As is the trend with other major dental work, crowns are also billed at around 50%, making it another expensive dental procedure for which your provider might pay half the cost.
Elements That Impact The Extent of Coverage Provided.
Insurance providers usually place limits on the coverage of implants in multiple ways. For instance, there are plans where an insured has to wait for a certain specified duration before he is eligible to get an implant. Most policies impose an annual coverage limit and there are some that impose coverage limits specifically for implants on a particular year or lifetime basis. Furthermore, insurers often impose deductibles ranging between 10% to 50% for implants, crowns and other prosthodontic procedures and the insured bears responsibility for the rest.
How to Determine If Your Insurance Plan Covers Dental Implants
When reviewing a policy for purchase or getting in touch with a dental insurance supplier, ensure you clarify If an implant plan will involve:
- Are dental implants systems comprehensive and cover implant, abutment as well as crown?
- Am I obliged to wait an allotted period before the implant can be billed to my remaining balance
- Does the plan have any coverage restrictions?
- Is there a cap on the amount covered for implants within a year and/or for my lifetime?
- What is the amount that you will reimburse for the dental implant system?
- Is the percentage coverage different between the implant and the crown?
- Do I need to satisfy a surrender fee before the coverage becomes effective? What amount do I have to pay?
- Is the extraction or bone graft chargeable, what is the co-payment or co-insurance terms, if any?
- Is care given prior and after the operation included in the expenses?
What are the Costs of Dental Implants if One Lacks Insurance?
In the absence of dental insurance, here are the typical expenses you can expect for dental implants:
- Tooth Extraction: $135
- Bone Graft with Implant Placement: $552
- Dental Implant Cost: $2,013
- Abutment Cost: $718
- Crown on Implant: $1,511
- One Tooth Total Cost: $4,929
If one has lost more than one tooth, an implant-supported bridge can be placed at an average of Aspen Dental’s cost, $6200. In addition, an implant-retained full denture is estimated to cost around $6800.
What is the Cost of Dental Implants with Insurance Coverage?
A lot of factors influence the total price of an implant when one has coverage including the fee set by your dentist and how much of the cost your insurer reimburses. So based on the review of 13 insurers, the coverage percentages for dental implants and crowns varied from 10% to 50% after the deductible was met for each plan. Thus, if an average cost of an implant is around two thousand dollars, an insured person can expect to pay between $1,000 and $1,800 for each implant after reaching the deductible. These figures are only for the implant body.
One must also consider the expenses incurred for the crown and abutment which is used with the implant. The estimated average cost of an implant-supported porcelain crown ranges between $755 and $1,360 with insurance. A pre-fabricated abutment cost anywhere from $358 to $645.4 Overall, after factoring in the insurance, the average cost incurred post-insurance for the combination of an implant, abutment, and crown is estimated at $2,113 – $3,805. The differing estimates heavily depend on what percentage of coverage is given by policy. If a bone graft or tooth extraction is necessary, there will be other additional expenses incurred.
Best Dental Insurance for Implants
| Provider | % of Dental Implant Care Covered | Average Monthly Premium | Dental Implant Waiting Period |
|---|---|---|---|
| Delta Dental | 50% after deductible | $64.92 | 6 months |
| MetLife | 50% after deductible | $43.89 | 12 months |
| Physicians Mutual | 25% after deductible | $30.50 | 12 months |
| Spirit | 25% after deductible | $37.96 | 0 months |
| DentaQuest | 50% after deductible | $42.11 | 18 months |
Ways to Select a Dental Insurance Company for the Purpose of Implants.
In case you are sure about proceeding with the implant, you have to be careful about which dental insurance plan you buy. When looking for a plan think about the following aspects:
- Premium: The set cost that has to be paid on a monthly basis to keep the plan operational.
- Deductible: The cost that is borne by the individual before the coverage starts to reimburse.
- Annual max benefit: The total amount the provider will pay in any one year’s period.
- Annual implant maximum: The cap on who much the policyholder can claim in one year for implant-related expenses.
- Lifetime implant maximum: The cap set on how much a policyholder can claim over a lifetime for being reimbursed for implants.
- Implant coverage percentage: The amount of estimated coverage that will be provided for the cost of implant surgery.
- Crown coverage percentage: This term refers to the portion of a crown’s costs that an insurance provider would pay for.
- Waiting period on implants: The duration for which you are expected to be without coverage for your implant costs.
- Waiting period on crowns: The time after which an insurance provider will start reimbursing for crowns after a person has been enrolled in their plan for certain period of time.
- J.D. Power Dental Plan Satisfaction ratings: The ratings given by J.D. Power are based on research done across customers and how they feel about the service provided.
- Each of these components affect the total cost that will be incurred for an implant under an insurance claim.
Dental Bridges
Dental bridges are yet another method of permanently replacing teeth. They normally include two crowns on either side with teeth (pontics) placed between them to fill a space. You can also have a Maryland dental bridge which uses metal wings to attach a bridge of artificial teeth to the backs of adjacent teeth instead of crowns. If, however, you only have one natural tooth on the side of the space, you can have a Cantilever bridge which has a crown on your natural tooth and a pontic that extends over the gap. So says Aspen Dental, which estimates the cost of a dental bridge on average at $4,313.
Are Dental Implants Cheaper With Insurance or Without Them?
Most dentists will charge different rates for dental implants, and the same goes for implants with a certain insurance plan. Still, the average price without dental coverage is around $2,000, while having insurance often yields a price between $1,000-$1,800.
How Can I Find Out How Much Are My Dental Implants Specifically?
The best way to determine what a dental implant will cost is to ask directly to a dental practice that will be performing that exact procedure. Additionally, provided insurance holders should reach out to their insurance providers to determine how much can be claimed for the procedure.
Is There a Cheaper Alternative to Dental Implants?
These solutions tend to be pricey, but you might be able to obtain dentures at a lower cost than a complete implant system.
Are Dentures Better Than Implants?
Some people would argue that dentures can be better than dental implants in certain situations. Non-implant dentures are less invasive as well as being cheaper, but these are only a temporary solution, when compared to implants which are permanent. The American College of Prosthodontics has suggested that dentures should be replaced every five years.
How Long Do Dental Implants Last?
With adequate care, dental implants can remain for a lifetime. However, the crowns that are attached to it last on average about 10-15 years. If you are a diabetic, have a periodontal disease, or don’t maintain good hygiene, then there are higher chances of failure.
Conclusion
A single dental implant can cost upwards of a few thousand dollars. There may be a way to reduce the financial burden by using an insurance policy, which might cover anywhere between 10% to 50% of the overall cost. In order to fully capitalize on your savings, it is prudent to shop around and analyze various policies. Along with the standard terms such as the deductible and monthly premium to be paid, pay particular attention to the implant coverage percentage, crown coverage percentage, maximum coverage limits and waiting periods.
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