Most dental insurance plans cover 10% to 50% of dental implant costs, but coverage varies widely by provider and plan. Some plans cover only the crown portion, others cover the implant post, and some exclude implants entirely as a cosmetic procedure. The average patient with dental insurance pays between $1,500 and $4,000 out of pocket for a single implant after insurance contributions.
Understanding your coverage before treatment helps you plan financially and avoid surprises. Here is what you need to know about dental insurance and implants.
What Part of Dental Implants Does Insurance Typically Cover?
Dental implant treatment involves multiple components, and insurance plans often cover different parts separately:
The Crown: This is the visible tooth portion and is most commonly covered by dental insurance. Many plans classify crowns as a major restorative procedure and cover 50% of the cost.
The Abutment: The connector piece between the implant and crown may be covered separately or bundled with the crown coverage.
The Implant Post: The titanium screw placed in your jawbone is less commonly covered. Some plans exclude this as a surgical or cosmetic procedure.
Preparatory Procedures: Tooth extractions, bone grafting, and X-rays needed before implant placement may have separate coverage under different benefit categories.
How to Check If Your Insurance Covers Dental Implants
Before scheduling treatment, take these steps to understand your coverage:
Call Your Insurance Provider: Contact the customer service number on your insurance card. Ask specifically about dental implant coverage, including the implant post, abutment, and crown.
Ask the Right Questions: What percentage of implant costs are covered? Is there a waiting period before implant coverage begins? What is your annual maximum benefit? Are there any exclusions for implants?
Request a Pre-Treatment Estimate: Ask your dentist to submit a predetermination request to your insurance company. This provides a written estimate of what your plan will pay before you commit to treatment.
Review Your Benefits Summary: Check your plan documents for details on major restorative services, surgical procedures, and any implant-specific exclusions.
Can Medical Insurance Cover Dental Implants?
In certain situations, medical insurance may cover dental implants when the procedure is considered medically necessary rather than cosmetic:
Accident or Injury: If you lost teeth due to a car accident, fall, or other trauma, medical insurance may cover the reconstruction.
Cancer Treatment: Patients who lost teeth due to oral cancer treatment or radiation therapy may qualify for medical coverage.
Birth Defects: Congenital conditions that resulted in missing teeth may be covered under medical insurance.
Disease-Related Tooth Loss: Certain medical conditions that cause tooth loss may qualify. Documentation from your physician explaining the medical necessity is typically required.
If you believe your situation may qualify for medical coverage, ask your dentist to provide documentation and contact your medical insurance provider to discuss your options.
What If Your Insurance Does Not Cover Implants?
If your dental insurance excludes implants or provides minimal coverage, several options can help make treatment affordable:
Dental Financing: Programs like CareCredit offer low-interest or no-interest payment plans that spread the cost over 12 to 24 months or longer.
In Office Payment Plans: Many dental practices offer their own payment arrangements that allow you to pay over time without third-party financing.
Health Savings Account (HSA): If you have an HSA, you can use these pre-tax dollars for dental implants. This effectively gives you a discount equal to your tax rate.
Flexible Spending Account (FSA): Similar to HSA funds, FSA money can be used for dental implants. Plan ahead since most FSA funds must be used within the plan year.
Dental Discount Plans: These are not insurance but membership programs that provide reduced fees at participating dentists. They can be a good option if you have no dental insurance.
How to Maximize Your Insurance Benefits for Implants
Strategic planning can help you get the most from your dental insurance:
Time Treatment Across Calendar Years: If you have multiple implants or your annual maximum is limited, consider starting treatment in December and completing it in January. This lets you use two years of benefits.
Use Your Annual Maximum: Most dental plans have an annual maximum benefit, typically $1,000 to $2,500. Plan treatment to use this benefit before it resets at year’s end.
Combine Dental and Medical Claims: If your implants qualify as medically necessary, you may be able to file claims with both your dental and medical insurance for different portions of the treatment.
Check In Network vs Out of Network: Using an in-network dentist typically means lower out-of-pocket costs. Ask your insurance company for a list of in-network implant providers in your area.
Dental Implant Financing in Newark, NJ
At Gentle Dental of NJ, we believe finances should not prevent you from getting the dental care you need. Our team helps patients navigate insurance coverage and find affordable payment solutions.
How we help with insurance and financing:
Insurance Verification: Our staff contacts your insurance company to verify your implant benefits before treatment begins.
Pre-Treatment Estimates: We submit predetermination requests so you know what to expect before committing to treatment.
CareCredit Financing: We work with CareCredit to offer flexible payment plans that fit your budget.
Multiple Insurance Plans Accepted: We accept most major dental insurance plans.
Bilingual Support: Our staff speaks English, Spanish, and Portuguese to help you understand your benefits clearly.
Led by Dr. Eugene Bernstein, DDS, our practice has been placing dental implants for over 24 years. Schedule a consultation to discuss your implant options and get a personalized cost estimate based on your insurance coverage. Call 973-817-8888 or request an appointment online.
Frequently Asked Questions
How much do dental implants cost with insurance?
With insurance covering 10% to 50% of the cost, most patients pay between $1,500 and $4,000 out of pocket for a single dental implant. Your exact cost depends on your specific plan, deductible, and annual maximum. Schedule a consultation to get a personalized estimate based on your coverage.
Why do some insurance plans not cover implants?
Some insurance companies classify dental implants as a cosmetic or elective procedure rather than a necessary restoration. Other plans exclude implants because of the high cost. Coverage has improved in recent years, and many newer plans include at least partial implant benefits.
Is there dental insurance that covers implants 100%?
Finding dental insurance that covers implants 100% is rare. Most plans that include implant coverage pay 10% to 50% of the cost after your deductible is met. Plans with higher implant coverage typically have higher monthly premiums and may have waiting periods before coverage begins.
Can I use my HSA or FSA for dental implants?
Yes, both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can be used for dental implants. These accounts use pre-tax dollars, which effectively reduces your cost. Check your account balance and plan your treatment accordingly, especially with FSA funds that may expire at year’s end.
How long is the waiting period for implant coverage?
Many dental insurance plans have a waiting period of 6 to 12 months before major procedures like implants are covered. Some plans have longer waiting periods of up to 24 months for implants specifically. If you are considering purchasing new dental insurance for implant coverage, ask about waiting periods before enrolling.
Disclaimer
Medically reviewed by Dr. Eugene Bernstein, DDS. This content is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Please consult a qualified healthcare provider for personalized recommendations.