Coverage for Dental Implants?

dental implant picture

redd road family dental.com

 

There is generally No coverage for implants. 

We did find THREE  Individual Plans from Dental for Everyone that will cover implants! 

Try turning your phone sideways to see the graphs & pdf's?

Liberty Dental Plan!

 

Liberty Dental DHMO plan features large group type benefits, but is not rated by age or zip code, and individuals and/or groups with no participation requirements!  

 Benefits Include: 

No Annual Maximums, No Claim Forms, Coverage for Pre-Existing Conditions, No Waiting Periods, Orthodontia, Dental Implants and More. 

Brochure and Enrollment Kit

 *When using the online provider link, select the CA-400 plan (not to be confused with the CA-400-R Plus) from the Benefit Plan /Network drop down. You will have to scroll down about half way to find it. Then select Zip Code, Country, State and City and click on the Search button.

Dental For #Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

VSP Vision Enroll ONLINE

What are Dental #Implants?

Dental implants (ADA Codes) may be thought of as artificial tooth roots which allow the fabricated teeth to be firmly attached to the mouth.  One may consider the jaw bone as a piece of wood and a dental implant as a screw

Learn more from REAL Dentists:

Write implants off your Taxes – using Health Savings Accounts

The average cost of placing a single dental implant ranges from $1,600 to $2,200, not including the cost of a restoration. Redd Road *

Implants may be covered under health insurance, if there is a “medical necessity” like cancer, major accident or skeletal deformity.  View sample Delta policy page 40 #32.

You can include in medical expenses the amounts you pay for dental treatment. This includes fees paid to dentists for X-rays, fillings, braces, extractions, dentures, etc.   including artificial teeth (IRS Publication 502 Page 5 & 7)

Implants are done when one doesn’t want a bridge because it more permanent and look better even in the back of the mouth and in view of this it’s considered cosmetic.

Unfortunately, implants are not generally a covered benefit. However, it is possible that Delta would provide an allowance for the covered benefit. It’s best that the enrollee ask their dentist to submit a pre-determination to Delta so that Delta can determine the covered benefit (if any) and the enrollees responsibility for payment in advance.

Limitations:

The replacement of lost or stolen dentures, crown and bridge work, dental procedures and charges incurred as part of implants (placement or removal) and prosthetic devices placed on implants (fixed or removable, for example: bridges, crowns) are not covered.  Smile Saver Brochure

Implants

Answers.com

Blue Shield Small Group Dental  PlansDental Implant Explanation

#Delta1 Dental No Wait

  • Delta Dental offers implant coverage for both groups and individuals:
    • Group-sponsored Delta Dental PPO™ plans vary and may include implant coverage.
    • Groups with DeltaCare® USA coverage can choose the i‑series plans for comprehensive implant coverage.
    • For individuals, the Delta Dental PPO Premium Plan covers implants at 50%, after a 12-month waiting period.

 

Delta No Wait

delta premier plan highlights

 

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.  MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

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Dental Max “Pretty” brochures

Renesasse - Coverage for Implaints
Highlights
Full Brochure
implants

Be sure to click on the button below to get a quote and the most current coverage information!

Liberty

 

liberty implant schedule

liberty implant schedule 2

No plan maximum 

 

 

#Importance of Dental Coverage 
Dental & General Health

Insurance 101?

We suggest that you check out Life Insurance, Disability, Long Term Care and Retirement as these risks may cause much more financial devastating to your budget than dental bills.

Picture of Oral Health 

Why you need Group Dental Coverage

 

Steve on buying, shopping and best use of premium dollars
Dental Insurance VIDEO

steve's video on dental coverage

MORE VIDEOS

#Alternatives to Implants

 

Gum Disease Treatment

If you have a tooth that is loose and may be “hopeless,” it might still be saved with gum disease treatment . If the gums are receding and there has been bone loss around the tooth, that doesn’t mean that the tooth is guaranteed to be lost.

With gum disease treatment, we can clean out the infection around your tooth, and hopefully the tooth will heal. Sometimes we might splint the loose tooth or teeth to natural teeth that are stable. This can help stabilize the loose teeth and give them time to heal. Then you’ll still have your natural tooth for longer, potentially the rest of your life. This costs significantly less than a dental implant. And Pinhole ® Gum Therapy can be used to restore the natural contour of your gums.

Caveats: For a tooth that is designated “hopeless,” the success rate is lower than that for dental implants. And because we’re preserving your natural tooth, it will continue to look as it had, so if you’re unhappy with the appearance of this threatened tooth, it might not be the best choice. Plus, sometimes the infection is so serious that we want to remove teeth to better control the risk that the infection could spread to other parts of your body.

 

Root Canal Therapy

 

If your tooth is threatened by an infection inside the tooth, we can use  root canal therapy to clean out the tooth and make it stable again. The tooth will be reinforced and topped with a dental crown . The success rate for root canal therapy is comparable to that for dental implants, and it has the benefit of retaining your natural tooth. Plus the dental crown means that the appearance of the tooth will be improved, too. If you later need to replace the treated tooth, you will usually be able to get a dental implant, and in the meantime, you get to enjoy the benefits of having a natural tooth rather than an implant. Cost is slightly less than for a dental implant.

Caveats: Whether a root canal is appropriate or not depends on the state of your tooth. If the tooth root is damaged, a root canal is not recommended. Sometimes an infected tooth can be a serious risk and needs to be extracted right away. Extraction is best for badly damaged or seriously infected teeth.

 

Dental Bridge

 

If you can’t save the tooth with either gum disease treatment or root canal therapy, you can often get a dental bridge that will perform the same function as a dental implant. With a dental bridge, the replacement tooth is supported by dental crowns on teeth next to the missing tooth.

Dental bridges are fully fixed in your mouth. They’re not loose and won’t slip out, so your diet won’t be impacted, and they can look as good as dental implants. Plus the dental crowns on neighboring teeth can be very helpful if they have been damaged.

Caveats: Dental bridges don’t stimulate your jawbone and gums the way a dental implant does. This may not matter, but it can potentially cause collapse of the gums under the replacement tooth. And if the supporting teeth aren’t fully healthy and strong, they may be put at risk by having a dental bridge placed over them. That’s because two teeth are now being asked to do the work of three. Because of this restriction, we only recommend dental bridges in limited situations where they don’t cause much increased risk to your natural teeth.

 

What about Dentures?

 

We didn’t mention removable partial dentures because they aren’t as good as dental implants. Removable dentures don’t look or function like natural teeth, and they can be uncomfortable, even damaging. This is especially true of removable partial dentures, which rarely work well enough to help you chew naturally. Removable partial dentures also collect food and plaque around them, encouraging tooth decay. Those secured with metal wires and hooks can erode teeth, increasing the risk of tooth loss.

An exception is The Denture Fountain of Youth®, which replaces all your natural teeth. This type of denture looks natural and encourages better biting and chewing function. While not as good as implant-supported dentures, they are close.   Kuzma *

Experts say 90% of patients with complete tooth loss opt for dentures.  Ivy Rose *

Learn More
Links & Resources

VIDEOS

 

 

 

13 comments on “Dental Implants – Coverage?

  1. give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare

    Adding dental, hearing and vision benefits to Medicare.

    Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,”

    Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

    https://www.fiercehealthcare.com/payer/framework-for-3-5t-senate-package-seeks-to-close-medicaid-gap-add-new-medicare-benefits-and

  2. What if I need MAJOR, EXPENSIVE Dental work and don’t have coverage.

    Can I buy it now?

    What are best options to open – start a dental plan to reduce this out of pocket cost?

    Any restrictions such as waiting periods to obtain this care after purchasing a plan?

  3. This is a FAQ from a page we culled from the website

    would be beneficial to me to switch to the enhanced 94 plan when I’m currently Under full scope of benefits Medi-Cal and denti-cal for about $7,000 worth of dental work that denti-cal won’t cover that needs to be performed?

    Are there any available plans Under The Inn at Silver 94 which offer Dental Care better than what is normally offered through denti-cal?

    Reply

    I really don’t know where you can get coverage for $7k worth of dental work. Most all plans I’ve seen limit coverage to $1k or $1.5k – $1,500/year.

    Silver 94 doesn’t have adult dental, other than if they call it medical services. See specimen policy page 72

    Check out Dental for Everyone or Covered CA’s dental program, which I believe you can get, even if you don’t have a health plan.

    What do you mean by “under the inn?”

    • See above for the Denti Cal – Medi Cal Member Handbook

      I’ll grant, that I don’t see on that page anything about implants, so here’s our research.

      The Denti-Cal provider handbook does mention Implants, so I guess it’s covered. I suggest you ask your dentist. Your question is beyond my pay grade! (Zero, as Medi Cal doesn’t pay agents)

      These are the “codes” in the provider manual that related to implants:

      Implant Services

      D6010, D6040, D6050, D6053, D6054, D6055, D6056,D6057, D6058, D6059, D6060, D6061, D6062, D6063,D6064, D6065, D6066, D6067, D6068, D6069, D6070,D6071, D6072, D6073, D6074, D6075, D6076, D6077,D6078, D6079, D6080, D6090, D6091, D6094, D6095,D6194, D6199

      See also Dental Economics.com

      Here’s why I don’t like to guess or answer questions on the phone. I checked with justice in aging.org/ and said

      “Single tooth implants are not a benefit of the Medi-Cal Dental Program

      Some legal advocates have attempted to make compelling medically necessary arguments, and the provider manual allows for that “Implant services are a benefit only when exceptional medical conditions are documented and shall be reviewed for medical necessity.”

      But generally speaking not a benefit and not one we want to promote as available to Medi-Cal beneficiaries since they are so limited.

      they pointed out this section in the provider handbook:

      Implant Services General Policies (D6000-D6199)

      a) Implant services are a benefit only when exceptional medical conditions are documented and shall be reviewed by the Medi-Cal Dental Program for medical necessity for prior authorization. Exceptional medical conditions include, but are not limited to:

      i) cancer of the oral cavity requiring ablative surgery and/or radiation leading to destruction of alveolar bone, where the remaining osseous structures are unable to support conventional dental prostheses.
      ii) severe atrophy of the mandible and/or maxilla that cannot be corrected with vestibular extension procedures or osseous augmentation procedures, and the patient is unable to function with conventional prostheses.
      iii) skeletal deformities that preclude the use of conventional prostheses (such as arthrogryposis, ectodermal dysplasia, partial anaodontia and cleidocranial dysplasia).
      iv) traumatic destruction of jaw, face or head where the remaining osseous structures are unable to support conventional dental prostheses.

      b) Providers shall submit complete case documentation (such as radiographs, scans, operative reports, craniofacial panel reports, diagnostic casts, intraoral/extraoral photographs and tracings) necessary to demonstrate the medical necessity of the requested implant services.
      c) Single tooth implants are not a benefit of the Medi-Cal Dental Program.
      d) Implant removal, by report (D6100) is a benefit. Refer to the procedure for specific requirements.

      They also told me about this guide for dental care for older adults

      Four page summary of dental benefits

      • 1. Searching for a reasonable rate plan for bone grafting…?
        2. How does dental cal, provide for patients that need bone grafting before implants…?

      • I AM 44YO ON SSDI I AM HIV HEP C

        I HAVE 10 MISSING / CRACKED TEETH AND

        THIS DETRAMENTAL TO MY MEDICAL HEALTH WITH ALL RISKS INVOLVED BY NOT HAVING MEDICALLY NECESSARY IMPALNTS TO REPLACE MISSING OR CRACKED TEETH

        IT ALSO MAKES IT DIFFICULT TO EAT THUS I EAT LESS OR UNABLE TO EAT MEATS MAKING NUTRITION A HEALTH CONCERN ..

        I RECEIVE DISABILITY INCOME AND CAN NOT AFFORD THE 15,000-20,000 BILL FOR IMPLANTS

        I HAVE AETNA MEDICARE ADVANTAGE DENTAL AND HEALTH BUT ITS A JOKE ON HOW LITTLE THEY WILL COVER

        WHICH LEAVES ME WITH A MOUTH FULL OF BROKEN / CRACKED/ MISSING TEETH AND

        I DONT KNOW WHO TO ASK FOR HELP OR

        WHAT INDIVIDUAL DENTAL POLICY I CAN BUY TO HELP MYSELF SO I CAN BE ABLE TO EAT, LIVE A HEALTHY LIFE BECAUSE STATISTICS SHOW IF I DONT DO SOMETHING ABOUT THIS NOW OR SOON IT WILL DECREASE MY LIFE EXPECTANCY AND IVE ALMOST DIED SEVERAL TIMES SO FAR IN MY LIFE SO I VALUE A LONG LIFE EXPECTANCY

        SO IF YOU COULD HELP ME PLEASE OR DIRECT ME ON WHAT TO DO OR WHO TO TALK TO BECAUSE I FEEL SOO LOST NO ONE OFFERS SOLUTIONS OR OPTIONS

        ONLY THAT THE MAX COVERAGE ANNAULLY IS 1500 AND NO SOLUTION ON HOW TO COME UP WITH THE REST.

        I MISS EATING STEAK, PISTACHIOS, ETC..

        I HATE THAT I EAT VANILLA YOGART A LOT BECAUSE ITS WHAT I CAN EAT NOT THAT I LIKE IT OR ITS A FAVORITE BECAUSE ITS NOT.

        I JUST FEEL LIKE I CANT DO ANYTHING WITH IN REACH TO HELP ME

        SO THIS IS WHY I AM CONTACTING YOU WITH HOPES YOU HAVE A SOLUTION.

        PLEASE HELP ME. SO FAR NO ONE HAS BEEN ABLE TO AND I BEEN ASKING FOR 2 YEARS AND THE LONGER TIME GOES BY THE WORSE THINGS WILL GET AND IMPLANT OPTION BECOMES LESS OF AN OPTION WITH EVENTUAL MORE TEETH LOSS WICH MEANS THE GAW BONE MIGHT NOT EVENTUALLY BE ABLE TO ALLOW IMPLANT OPTION AND

        I DONT WANT TO WAIT THAT LONG

        WERE NOT THERE YET BUT EVENTUALLY IF NOT SOON IF SOMETHING ISNT DONE

        I DONT KNOW WHAT TO DO SO AGAIN

        I ASK OF YOU STEVE I AM A 44YO MALE ON SSDI MEDICARE ADVANTAGE PPO WITH DENTAL OPTION INCLUDED

        WHAT DO I DO? I LIVE IN SAN DIEGO xxxx3 IS MY NUMBER IT WORKS WHEN I CAN CONNECT TO FREE WIFI SO PHONE CONVERSATIONS HAVE TO BE SCHEDULED..

        I LOOK FOWARD TO YOUR HELP. KIND REGARDS, JOSEPH R

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