Keeping your teeth or dental health in check is very important as it plays a very significant role in improving your overall health. One of the most popular ways of keeping your dental in check is dental implants. Dental implants are done to help patients to replace their lost teeth, which improves self-confidence and strengthens the bone structure, along with other benefits. Although dental implants are important, getting through the process can be costly. As a result, you should get your dental insurance to cover the cost of this procedure. Getting dental implants covered by insurance is not a walk in the park. Fortunately, this tutorial will help you land good insurances that cover dental implants. We will also discuss how to get dental implants covered by insurance and other methods of getting dental implants if your insurance does not offer the services. Please come with us!
Does My Insurance Cover Dental Implants?
Before you sign up for any dental insurance, it is good to know whether it covers dental implants. It is good to understand different parts of dental implant procedures and know whether they are covered in your insurance plan. Kindly note that the amount of coverage is dependent on the intensity of each treatment procedure. In this section, we shall discuss various steps of dental implants and whether each step is covered by insurance.
- Tooth Extraction: This is the first step of your dental implant treatment that involves extracting damaged teeth so that you can replace it through implant. Perhaps your teeth has excessive tooth decay, crowding or tooth infection; there are several reasons why you will be required to extract your teeth. This procedure however, doesn’t happen to patients whose tooth is already missing. Luckily, most dental insurances cover the cost of this implant treatment step, either partially or in full.
- Bone Grafting: This is another teeth implant procedure where victims need an underlying jawbone reinforcement before the implant process commences. This surgical process involves using bones from other body parts to the affected region, in our case, the jawbone. This makes your jawbone secure and stable for the implant. Unfortunately, this stage of teeth implant is not usually covered by most dental insurance.
- Placing the Implant: After stabilizing your jaw bone, this is the next step that is usually defined as the major procedure. Most insurance companies consider implant placement “major” dental surgery. However, the word “major” should not scare you because its use does not reflect the treatment intensity. Some insurance companies cover up to 50% of major procedures during implant placement.
- Placing the Artificial Tooth: This tooth treatment involves mostly placing an abutment extension on the dental implant to replace the crown. Its primary role is to give your tooth a natural tooth look. The process of placing the tooth is also considered by many insurance companies a “major” procedure. In most cases, insurance companies consider it the same as crowning a natural tooth, making it more costly. As a result, you must check it with your insurance company before subscribing to your chosen plan.
How to Get Dental Implants Covered by Insurance
In the above section, we have seen different types of dental implant treatment that insurances mainly cover. In most scenarios, people usually access dental insurance via the employer, leaving those underinsured or uninsured unprivileged. Such groups include those receiving Medicare beneficiaries who must buy an insurance policy to access dental coverage. You can buy a standalone policy from the insurance company or via market place.
This section will give you guidelines to help you when picking your dental implant insurance provider. Kindly note that you can buy a plan at www.healthcare.gov, which must meet the standards that the Affordable Care Act has set. Let us get into the guide;
Speak to your OMS
The first step is to talk with your Oral and Maxillofacial Surgeon about the insurance that you should take. The OMS will summarize everything the surgery entails, including the treatment type. The information you will get from the OMS will help you talk to your insurance company about the policy you should take.
Contact your insurance company
After gathering the information from the surgeon, the next step will be to contact your insurance company to acquire a policy. Kindly note that looking through all your dental insurance company details can confuse you. This is because of some loopholes that depend on the place your surgery will be done or the annual limit of the policy.
After talking to your insurance company, you will learn several things concerning dental insurance policies. For example, some dental plans may cover crowns attached to the abutment, mostly found when placing an artificial tooth. Others can cover dental implants that cover some medical complications like tooth loss. Some dental implants due to injury or accident can be covered by medical insurance.
This is the information your insurance company will give you before you take a policy with them. Kindly note that some policies may not cover implants for lost teeth before you accept their policy.
Get your current insurance policy and go through it
If you have an insurance plan, kindly go through it before getting a new dental plan and get to know its terms. Understand what it states, the benefits it offers you, and if it can cover dental implants. Sometimes, you may have a policy that can cover dental implants, but you overlook it somehow. Look if there is somewhere in the policy that states “dental implant,” and then mark it. Some of the insurance that covers accidents and injuries may cover teeth replacement through dental implants.
Scan the current policy for the annual maximum
The annual maximum is the amount the insurance company should pay you for dental procedures. Get to know if you can ask for reimbursement on the dental implants. Kindly get the Indemnity Dental Insurance and apply if the insurance allows you to pay for the implants and then be reimbursed.
If this is the only method of payment you are planning to use, ask your dentist to break down a plan that will suit your budget. This will help you manage your treatment with the minimal expenses possible. The insurance company will be able to reimburse preventive care costs 100% and 50-80% of the dental implant price.
Get a new insurance plan
If the above step does not help or you do not have a dental insurance policy, it is time to get an insurance plan. You will only need to search www.healthcare.gov/ and look for a policy that covers dental implants. Kindly ensure that most treatments are covered in the plan you have decided to pick.
Check for alternative financial options
As we have seen above, insurance may only cover some of your dental implant costs. As a result, you need to consult with your OMS about other financial options that support oral healthcare. Some organizations offer financial support for oral health to United States residents. You cannot equate money with the benefits you get from dental implants on your teeth. So, the cost of the dental implant should not prevent you from getting it.
7 Best Insurance for Dental Implants
Getting a stand-alone dental insurance plan may be the best solution for oral health. To be sincere, maintaining healthy teeth is costly when you do not have an insurance plan. As a result, you need a dental insurance policy that can factor in the copays, premiums, and all deductibles that make an individual policy very expensive.
This section will discuss some of the best dental insurance plans for 2022 to help you find dental care that works for you. Let us quickly dive into that and unravel this hidden mystery.
1. Delta Dental Insurance
Delta Dental Insurance is considered the best plan when you have braces. It is among the few insurance providers in the United States offering orthodontic benefits to children and adults. Dental Delta has five plans listed on its website; the availability and benefits of the plans differ depending on your location. Two orthodontic coverages are available for New York, Florida, and California residents. These include;
- Delta PPO Premium
This plan covers 100% of your routine care and up to 50% cost of the basic and major procedures. Generally, orthodontics gets 50% coverage of up to $ 1,500-lifetime maximum.
- Delta Care USA
This plan has fixed copayment rates starting with preventive, basic, and major services. The only challenge with this plan is its limited network; you must pay an upfront annual premium.
- It has a low NAIC complaint index
- You can get on state and federal exchanges
- You can get teeth whitening from some plans
- It is available nationwide
- It offers comprehensive dental benefits
- It does not have an upper age limit which makes it suitable for many families that need orthodontic coverage
- The plans are not uniform in all states
2. Denali Dental
Denali Dental has three insurance plans covering individuals in all age brackets. The company’s primary goal is to provide affordable dental care that does not have waiting coverage. Even though Denali pays part of your treatment, you must be prepared to pay the larger part of your bill. However, unlike other dental insurance plans that may take you a month, Denali’s Dental plans do not have a waiting period.
Fortunately, you will benefit from four cleanings and two teeth exams annually, paid for by Denali Dental. Kindly note that there will be no coverage for replacing teeth that you lost before the day the policy took effect. Below are the services Denali covers;
- Preventive: This one involves two exams and four cleanings contacted every year.
- Diagnostic: It ensures you get one series of Bitewing X-rays yearly.
- Basic and Major services: This involves the following;
- Simple extraction
- A diagnostic X-ray is usually done after three years.
- Oral surgery.
- Endodontic treatment
- Periodontal services
- Restoration services include inlays, on-lays, and crowns.
- Prosthetic services
- Endosteal implants
- It has multiple plans
- There is an increase in annual maximum benefits
- The deductibles are incredibly reasonable.
- You will get a low major services coverage in the first year.
3. Spirit Dental & Vision
This is one of the best plans, especially for no-waiting period residents. Spirit Dental offers two plans, Pinnacle Choice and Pinnacle Network, which have an annual maximum of $5000, except in Connecticut, Ney York, and Illinois. This benefit is significant for most people who want to finance major procedures like dental implants. Kindly note that you will have to pay high premium rates for three years to qualify for the full $5000.
Its plans are subdivided into two options.
- Network plan that provides the best rates with the approved network.
- Choice plan: This gives you the freedom to pick the provider you prefer and does not have any network requirements. However, to enjoy this freedom, you will have to part with some good bucks because of the higher premium charges.
- It is available in almost 50 states
- Users have three dental cleaning covers three times a year.
- It has a high annual maximum limit of $5000
- The rates are expensive
- It does not have HMO plans.
Ameritas provides three policies that have comprehensive, in-network, and out-of-network coverage. Among the three, two plans have increased payouts of up to $2000 per year.
- There are three plans that you can choose from
- It has a higher annual maximum of $2,000
- It has cheap premiums from $25 to $57
- It covers teeth whitening.
- It does not have adult orthodontic care.
- You will have to wait until after first to get 100% preventive care.
5. Cigna Dental
Cigna Dental is one of the insurance providers with the best nationwide coverage, with its services available in over 300,000 locations. Residents in over 50 states can benefit from Cigna Dental insurance plans. The good news is that Cigna has two plans with preventive, basic, and major coverage and one preventive. You will find such benefits with few insurers in the United States.
- Cigna Dental Preventive: this plan covers 100% of your preventive care and does not have a deductible or annual limits.
- Cigna Dental 1000: this plan covers 100% of your preventive care and 80% covering basic services. Besides, it pays 50% of the major work and has an annual payout limit of $1,000.
- Cigna Dental 1500: this plan has the same coverage percentage rates as Cigna Dental 1000; the only difference is in the annual limit, which is $1,500. This limit covers orthodontia for both children and adults. This means you will receive 100% preventive care coverage, 80% of the basic services, and major work will get 50% coverage.
Kindly note that you still get an insurance plan with sigma if you lose your job or retire and want to switch the insurance to get immediate dental care. If you have had dental insurance in the last 12 months, you will receive waivers on all waiting periods.
- It offers competitive benefits for all dental care, for example, preventive.
- You will get up to a 15% discount on every eligible dependent added to your policy
- It is ranked fourth in J.D Power, meaning it is one of the best
- It does not cover implant coverage
- It has a high NAIC complaint index.
6. Renaissance Dental
Renaissance Dental has two policies covering implants for a maximum of $1,000. Fortunately, its services are available nationwide, meaning many residents can access the plan.
- You can get 50% payment for implants up to an annual maximum of $1,000
- You are allowed to choose any dentist.
- It has lower monthly premiums compared to many insurers.
- You must wait for 12 months to get major coverage
- The plans are not available in all states.
Anthem is one of the exceptional insurance providers with more than 41 million subscribers countrywide. It has a maximum annual of $2,000 that has the carryover benefit, with its availability being in over 14 states. The annual carryover function means that you can add the benefits current year to the following year.
- It has a 6-month waiting period which is small compared to insurers with one year.
- It has a $2,000 annual maximum
- You can get excellent group plans though through your employers.
- You will get a waiver on the waiting period if you have proof of previous coverage
- It is only available in 14 states.
- Rates usually vary with your location.
Guide to Choosing the Best Dental Insurance for Implants
Several factors are typically used to rank the best dental insurance company for implants. To help you choose the insurance, below are some of the terms that you must understand;
- Insurance coverage: Insurance coverage mainly represents two key areas, preventive and basic or major procedure services. Most insurance plans have 100% coverage on preventive services and 50% on major and basic procedures.
- Annual limits: The annual limit, also known as an annual maximum, is the limit of money your insurance company can pay you annually. Most of these companies pay their subscribers from $1,000 to $2,000. It’s therefore crucial to select dental insurance with high annual income limits so that most of your implant costs are covered.
- Coinsurance amounts: You should also consider your insurance’s coinsurance amounts before signing in to their services. The coinsurance amount is the amount of money that you pay after you receive the insurance benefit. For example, if you get 50% from the insurance to cover your treatment, you must pay the remaining 50% coinsurance amount. Kindly note that some companies increase the percentage of the money they pay the longer you stay with them. This means that your coinsurance amount will go on reducing with time.
- Deductibles: This is another important factor to consider when choosing the best dental insurance for implants. This is the amount you pay for your health insurance coverage before the insurance plan starts paying you. All the subscribers must pay the amount set before dental insurance starts to pay you the benefits. Some policies usually reset annually, while others have lifetime deductibles that are not renewable yearly.
- Sign-up process & waiting period: This is the time you need to wait after subscribing to dental implant insurance before you start receiving the benefits. Most companies have a 12-month waiting period, after which you will start receiving the annual maximum. Kindly note that there are companies that usually have a waiver to the waiting period meaning you can get the benefits immediately after approval.
- Requirements & LEAT clause: The LEAT clause is a limitation that many insurance plans have, reducing the benefits to the least expensive treatment option. LEAT is an acronym for Least Expensive Alternative Treatment, and you will find it in most dental insurance policies. For example, the insurance will not cover an implant if there is a LEAT on the policy.
- Geographic availability: Geographic availability refers to the different variations an insurance plan will have for a different population. For instance, you will find different services offered by the same insurance company in different states.
- Customization options: This functionality in an insurance policy allows you to customize your payment plan and pay for the coverage you need. So, you need to check if the plan you subscribe to can be customized to suit you.
If My Insurance Does Not Cover Dental Implants, Can I Get Help Elsewhere?
You can seek help from several alternatives if your insurance does not offer dental implants. These include;
- You can join a savings plan with a dentist in your local area. This will help you have monthly or yearly savings that will eventually be used to cover the dental implant.
- You can start hunting discounts from dentists who offer huge discounts after paying upfront. Kindly note that the materials used to conduct dental implants using this method may not be of good quality.
- You can also look for a dedicated dental clinic in your area. You may be lucky to get a federally free dentist who will do the implants at a lower price.
- You can consider looking for federal programs and see whether you will be assisted. An initiative like Medicaid usually helps those who are underpaid in paying for their medical services. Medicare is a national insurance program that helps seniors over 65 and other unprivileged. So, if you fall into that category, you can apply for the program and seek if you will get a dental implant.
- You can also look if there is a clinic that is offering free dental implants for testing. This directly implies that this process needs you to take a risk. However, the process is usually done by experts only they may be testing a new product in the market.
- You can join a dental network, pay its membership and receive huge discounts from authorized dentists during your teeth implant.
- You can consider signing in for dental discount plans which allow you to save huge during your teeth implant.
- You can also get a free dental implant after joining any authorized dental school, whereby you can be lucky to get a free implant when students are doing their practicals.
Is Paying for Dental Implant Insurance Worth It?
Yes. Dental insurance is worth paying because many insurance policies do not cover major procedures or surgery. Because dental implants are so expensive, getting extra coverage waived is a plus. This is because it makes dental implants more affordable to many people.
What Medical Insurance Covers Dental Implants?
Medical insurance rarely covers dental implants. There are very few occasions that medical insurance covers dental implants. For example, if you have a car accident, your insurance policy may have clauses saying you are entitled to one tooth replacement. However, this is always limited to only when you have an accident.
Do dental implants prevent gum disease?
No. Once you get a dental implant, it does not mean your risk of getting gum disease has been prevented. You must ensure that you care for your teeth and gum to prevent diseases like peri-implantitis.