Asking if something is covered by dental insurance is a tricky question. The reason why is because so many types of oral health procedures are broken down into multiple “codes” that are used when the insurance claim is filed. It’s up to the insurance company to decide which code is covered or not.
When it comes to dental implants, there are a number of codes that come into play when the treatment is being planned. That’s because a dental implant is not a single treatment, but a combination of multiple procedures.
For example, each of the following procedures may be part of your dental implant treatment plan:
Bone or soft tissue graft: This helps to strengthen the area where the dental implant is going to be placed, especially if there isn’t enough bone already to support your new tooth. It can add to the cost of getting an implant and may be covered at a different percentage than the implant is.
Sinus lift: If you’re getting a dental implant on your upper jaw, your dentist may need to raise the sinus lining above where it will be seated, especially if you’ve gone a long time with a missing tooth in that area.
Implant placement: Your dental implant is a titanium, artificial tooth root that’s set into the jaw. It requires a minimally-invasive surgical procedure. The cost of your implant placement may automatically include anesthesia, but not necessarily the “tooth” (dental crown) that will be fastened to the implant.
Abutment and restoration: After your implant site has healed for a few months, the top of the restoration will be uncovered, and an abutment seated into it. This extension is what supports the crown, bridge, or denture that is to follow. When asking your dentist how much dental implants cost, be sure to find out if this includes the cost of your new restoration.
When Your Benefits Max Out
Sadly, by the time a person has invested in a sinus lift, implant placement, and then their new crown/denture, their insurance plan is usually maxed out. This means that even after paying for their deductible and co-insurance (“co-payment”) their insurance benefits won’t cover everything that’s left. Some additional out of pocket expenses will still be incurred. The only way to change that is to spread the treatment out over another calendar year, when the benefit plan resets itself. But that means longer amounts of time without a tooth, or with your implant procedure only partially completed.
What Parts of Dental Implant Treatment Does Insurance Cover?
Dental insurance may cover dental implants. Until a few years ago, many insurance carriers still presumed that implants were an elective or above-and-beyond procedure that was not included in the standard benefit plans. Today it’s different. Most insurance companies have listened to the requests of dentists and their patients asking for benefits for this highly successful treatment. As such, it’s usually assumed that most dental carriers will include implants under the benefits they offer to plan participants.
Your implant and crown (or other restoration) will likely be covered as long as they don’t reach the “maximum allowable” amount that’s predetermined by your insurance plan – typically $1000-1500. That means if your implant costs $3,000 and your deductible is $500 followed by a 50% co-payment, you’ll be paying a good part of the procedure cost out of pocket.
An Easier Way to Afford Dental Implants
Getting dental insurance to cover implants can take a lot of guesswork and planning ahead. An easier way to make the math work in your favor — and still afford all of the treatment that you need — is to consider joining a CalDental dental savings plan (also known as a dental discount plan). These CalDental savings plans do not have annual spending limits. That means no matter how much dental treatment you need, you can still get a discounted rate from your participating dentist.