Dental Implant Insurance — Quick Answer

• Yes, some private dental insurance plans may help pay part of the cost of dental implants.
  • That does not usually mean the insurance company will pay the entire implant bill.
  • Coverage can depend on the particular plan, waiting periods, deductibles, annual maximum benefits, provider networks and exactly which parts of the implant treatment are covered.
• Already been told you need an implant?
  • Do not buy a dental plan simply because the brochure says it covers “major dental” or “implants.”
  • Compare the actual benefits and limitations before enrolling.
    • Compare Dental Insurance Plans & Get Quotes

Already Need an Implant?

Check These Before Buying Dental Insurance

• Does the plan specifically provide benefits for dental implants?
  • Do not assume that coverage for “major services” automatically means the entire implant procedure is covered.
• What parts of the treatment are covered?
  • Ask about the implant itself, abutment, crown or other restoration, extraction, bone grafting and any related treatment your dentist says you need.
• Is there a waiting period?
  • If you already know that you need an implant, a waiting period can make a plan much less useful for your immediate treatment.
• Is there a missing-tooth or replacement limitation?
  • Some plans have special rules concerning teeth that were already missing before your coverage became effective.
• What is the annual maximum benefit?
  • Even a plan that pays a percentage toward implants may stop paying once you reach its annual maximum.
• Does the dentist participate in the plan’s network?
  • An in-network dentist may have negotiated fees that can reduce what you pay, depending on the plan.
• Ask for a pre-treatment estimate before beginning expensive work.
  • Have the dental office submit the proposed treatment to the insurance company when the plan allows it so you have a better idea of what the plan expects to pay and what you may owe.
• Ready to compare?
  • Compare available dental plans here.

Why “50% Coverage” May Not Mean Insurance Pays Half Your Implant Bill

• A dental implant treatment may involve several separate procedures and charges.
  • Depending on your treatment, there may be charges for the implant body, abutment, crown or other restoration, extraction, imaging, bone grafting or other services.
• Your plan may treat those services differently.
  • One part of the treatment may be covered while another part is excluded, limited or paid at a different percentage.
• The annual maximum can be just as important as the advertised percentage.
  • For example, even if a covered service is payable at 50%, the insurance company generally will not pay more than the remaining annual maximum allowed by the policy.
  • Other dental claims during the year may also use part of that maximum.
• Compare your estimated total cost — not merely the premium.
  • Look at the premium, deductible, covered percentage, annual maximum, waiting period, network price and services that are excluded.
• Not sure which plans to look at?
  • Compare Dental Plans & Benefits

• Resource:
  • FDA — Dental Implants: What You Should Know

Ways to Reduce Your Dental Implant Costs

• Compare dental insurance before treatment starts.
  • Compare dental plans, benefits and premiums here.
• Check whether your dentist is in the plan’s network.
  • Depending on the plan, participating dentists may agree to negotiated fees that can lower the amount on which your share of the cost is based.
• Get a written treatment plan and pre-treatment estimate.
  • Ask the dentist to identify each procedure that will be performed and the estimated charge.
  • Then compare that treatment plan against the insurance benefits before committing to expensive treatment.
• If treatment can safely be done in stages, ask your dentist about the timing.
  • Dental plans commonly have annual benefit maximums. If your dentist says treatment can appropriately be spread over different benefit years, that may affect how much insurance is available.
  • Your dentist — not the insurance company — should determine whether delaying or staging treatment is medically appropriate.
• Ask your dentist about reasonable alternatives.
  • Depending on your dental condition, alternatives might include a bridge, partial denture, full denture or another restorative treatment.
  • The best clinical choice is a decision for you and your dentist.
• Dental discount plans are another possibility.
  • A discount plan is not insurance. It may instead provide access to negotiated charges from participating dentists.

Can You Use an HSA or Get a Tax Deduction for Dental Implants?

• Dental treatment can qualify as a medical expense under federal tax rules.
  • IRS Publication 502 includes dental treatment and artificial teeth among medical and dental expenses that can qualify.
• That does not mean everyone gets an income-tax deduction.
  • For an individual itemizing medical expenses, the federal deduction is generally limited to qualifying unreimbursed medical and dental expenses exceeding 7.5% of adjusted gross income.
• If you already have money in a Health Savings Account (HSA), qualified dental expenses may generally be paid with tax-free HSA distributions.
  • HSA rules have additional requirements, so review the IRS rules for your particular situation.
• Want more information about HSAs?
  • Visit our Health Savings Account — HSA page.

• Resources:
  • IRS Publication 502 — Medical and Dental Expenses
  • IRS Publication 969 — Health Savings Accounts and Other Tax-Favored Health Plans

Tax rules depend on your individual circumstances. Consult your tax adviser regarding your eligibility for any particular deduction or tax treatment.

Have Medi-Cal or Medicare?

The Rules Are Different

• Do you have Medi-Cal?
  • This page is primarily about private dental insurance.
  • Medi-Cal has its own rules concerning dental implants, medical necessity, documentation and prior authorization.
  • Does Medi-Cal Cover Dental Implants? — Read our dedicated guide.
  • Medi-Cal Dental Coverage — Benefits, Dentists & Other Dental Services
• Do you have Original Medicare?
  • Original Medicare generally does not cover routine dental care or items such as dentures and dental implants.
  • Medicare can cover certain dental services when they are directly related to specific Medicare-covered medical treatment.
  • See our Dental & Vision Coverage Under Medicare page.
• Do you have a Medicare Advantage plan?
  • Some Medicare Advantage plans include additional dental benefits, but the amount, procedures covered, provider rules and limitations vary by the particular plan and year.
  • Check the plan’s current Evidence of Coverage or dental benefit documents rather than assuming that one company’s dental benefit applies to every plan.

• Resource:
  • Medicare.gov — Dental Services Coverage

Dental Insurance — Related Pages & Get Help

• Compare Dental Insurance Plans
  • Get dental quotes and compare available plans. Quotit
• Main Dental Insurance Page
  • Dental Insurance — Plans, Coverage & Options
• Medi-Cal Dental
  • Medi-Cal Dental Coverage — Benefits, Dentists & Implants
  • Does Medi-Cal Cover Dental Implants?
• Medicare Dental
  • Dental & Vision Coverage Under Medicare
• Health Savings Accounts
  • HSA — Health Savings Accounts & Qualified Medical Expenses
• Want help comparing dental insurance?
  • Email me directly at [email protected].
  • Schedule a Zoom meeting with Steve Shorr.
  • Compare Dental Plans

• Important:
  • We are an insurance agency, not a dental office. We do not diagnose dental conditions, recommend dental procedures or perform dental treatment. Your dentist should determine the appropriate treatment, and the actual insurance policy or Evidence of Coverage controls what the plan pays.