Dental implants have become a popular choice for people seeking to restore their smile and improve their oral health. However, the cost of dental implants can be a concern for many individuals considering this treatment option.
One common question that most people ask is: does medical insurance cover dental implants? While the answer is not always straightforward, understanding the basics of insurance coverage for dental implants can help you navigate your options.
In this article, we will explore this topic in detail while discussing what dental implants are, how they work, and how to get dental implants covered by insurance. By the end, you’ll have a clearer picture of what to expect and how to proceed if you’re considering dental implants as a treatment option.
What are Dental Implants?
Dental implants are scientifically generated root replacements that are inserted surgically in the jawbone to back a replacement tooth or a bridge. They provide a permanent solution to missing teeth that allows you to have your own teeth again and can help you in your dental health.
The most common alloy for the implant itself is a biocompatible element titanium because it accepts the body well. In the long run, the implant similarly fuses with the jawbone in the process known as osseointegration, which helps maintain stability and the support of the replaced tooth.
Does Medical Insurance Cover Dental Implants?
Looking for does medical insurance cover dental implants? In general, medical insurance companies do not cover dental implant costs and people have to bear these expenses out of pocket. In almost all medical insurance plans, dental implants are considered to be an aesthetic issue and not included in the benefits there are. On various occasions, the rule differs though.
Some medical insurance plans can provide coverage for dental implants, even though this procedure may be considered medically necessary. Likewise, in situations where you have experienced tooth loss as a result of an accident or injury, medical insurance may cover the expenses of dental implants as part of your treatment program.
It is significant to state that dental implant coverage could fluctuate significantly from one health insurance provider to the next and from one health plan to another. Make sure you contact your insurance provider to get informed about their terms and conditions before you settle for dental implants.
Why Dental Implants Lack Insurance Coverage?
Here a question arises: why do dental implants lack insurance coverage? Well! Dental implants are rarely covered by medical insurance, as it is believed they fall under expenses associated with a cosmetic procedure instead of treatment as a medical necessity. Many plans will have cosmetic surgery excluded or not covering dental implants which is also considered as a cosmetic treatment.
Insurance agencies assess the implants as elective surgery and on the basis that they don’t ensure the continued healthy functioning of the oral cavity or an individual generally. This creates an outcome where they are not regarded as beneficiaries of medical insurance plans in most cases.
On the other hand, there is an aspect where the laws are not completely in line. Concerning dental implants which are considered to be medically necessary, the insurances that have that coverage are types of insurance that provide the coverage when they are used to correct oral dysfunction (e.g. eating, chewing or speaking) or when they are needed to correct the defects that are caused with a trauma or an accident.
How to Know If Your Dental Implants Are Covered?
How to Know If Your Dental Implants Are Covered?Want to know whether your dental implants are covered or not? To determine if your dental implants are covered by your insurance, follow these steps:
Review Your Insurance Policy:
You may be anxious about reading through your insurance policy documents but you can directly reach out to the insurer as well. Watch out for any provisions in the policy concerning dental implants.
Ask Your Dentist:
Your dentist may be the ideal person to clarify the details about your dental insurance regarding dental implants. In addition, they can help you develop a step-by-step treatment plan with the expenses spelt out.
Submit a Pre-Authorization Request:
You, being uncertain of your benefits, have the option to ask for prior authorization from your insurance provider. This entails giving them the details they can use as a reference to establish if the implant that is recommended is the one that they would have in mind.
Explore Alternative Financing Options:
If your insurance policy will not cover the full cost of implants or will only pay a significant portion of it, inquire with your dentist about other possible payment plans. Besides, multiple dental offices may list this option as a way to lower the costs for potential patients.
Appeal a Denial:
Your insurer might also not provide you coverage for implants, in which case, you may have the option to appeal this decision. Include any other information or supporting materials that prove the medical necessity of the treatment desired.
Having accurate information about your insurance plan in terms of dental implants is very important. If you take these steps in mind, you can prevent yourself from feeling overwhelmed by the process and instead be making a better decision about your dental health.
How Much Do Dental Implants Cost With Medical Insurance?
The cost of dental implants with insurance may vary differently from one patient to another. The amount you pay varies based on your insurance plan, coverage limits, the amount of deductible from which your payments vary, and the copayments that you contribute after the deductible is met. Primarily, it does not provide you full coverage for the implants.
The average cost of a single dental implant is $1,500-$3,000 and the accommodation of such procedures as bone grafting and sinus lift, which may be necessary in some cases, also leads to cost overruns. Having insurance in place will ensure that whatever contribution you may have to take out of the covering pocket for the expenses, which may be deductibles, copayments or any other expenses which are not covered by the insurer.
You should certainly go through your insurance policy and make a call to your insurance provider to get clear about the coverage available for dental implants. Your dentist will also design a treatment plan that briefs you on the estimated costs of the treatment as well as any kind of insurance coverage you may have.
How Much Do Dental Implants Cost Without Insurance?
Without dental insurance, the cost of dental implants can vary depending on the specific treatment plan and any additional procedures that may be required. However, on average, you can expect the following costs for dental implants without insurance:
- Extraction: $135
- Bone graft at the time of implant placement: $552
- Dental implant: $2,013
- Prefabricated abutment: $718
- Implant-supported crown: $1,511
- Total cost for one tooth: $4,929
For multiple missing teeth, an implant-supported bridge may be an option, with an average cost of $6,200. Additionally, implants can be used to support full dentures, which have an average cost of $6,800.
It’s important to note that these are average costs and actual costs may vary based on your location, the complexity of your case, and the specific treatment plan recommended by your dentist.
How to Save on Dental Implant Costs by Using Insurance?
Do you want to save on dental implant costs using your insurance plan? Well! Consider the following tips for this:
Choose an In-Network Provider:
Pick the dentist or the oral surgeon within your insurance plan that accepts it as a way of settling your bill. The majority of in-network providers are directly in contract rates with insurance companies, thus digit higher out-of-pocket costs do not come your way.
Understand Your Coverage:
Go through your insurance policy with great care to get an idea of what is covered and what is not covered. Make sure limits and deductibles are known, and that you understand the meaning of each of them.
Maximize Your Benefits:
If your insurance plan has a yearly plan on the amount of the benefits, try to schedule the dental implant procedure towards the last months of that year to pay your claims against the yearly benefits limit.
Combine Insurance Coverage:
In case you have complimentary insurance (for example, dental and medical), you will probably find out that you can use both plans (for dental needs and different parts of the dental implantation procedure, correspondingly) as well. By doing this, you can therefore bring down your OOP expenditure.
Explore Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs):
In such a case, use your health savings accounts or medical flexible spending accounts, and pay for your dental implants with pre-tax dollars, therefore decreasing the total amount that you would pay for your treatment.
Consider Supplemental Dental Insurance:
If your current health insurance plan does not cover dental implants, find an option with supplementary insurance. While you have to decide to reduce fuel consumption, don’t forget to add up the extra insurance cost against how much you can save.
Being proactive regarding the coverage of your insurance plan and its policies towards dental implants will help you to save out-of-pocket costs on dental implants.
Conclusion
Though medical insurance usually doesn’t pay for tooth implantation, certain cases are an exception. If you have lost teeth due to an accident or injury, or if your oral health gets worse and you can no longer eat or speak properly, your medical insurance may cover the cost of dental implants. You might want to reach out directly to your insurance provider to find out about your specific dental implant coverage options.
References:
https://www.investopedia.com/how-to-get-dental-implants-covered-by-insurance-8580639
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