Health insurance and dental coverage can be confusing, especially when it comes to the coverage of specialty dental procedures like dental implants. Many of our patients ask us whether their dental insurance will cover dental implants, and the answer is that it depends on your insurance and the type of implant treatment you receive. Dr. Mark Sowell of Sensational Smiles in Plano, TX will work with you and your insurance company to create a treatment plan that fits your needs and budget.
Understanding Dental Insurance Coverage
Many insurance companies consider dental implants a purely cosmetic procedure, and therefore not medically necessary. Most dental insurance plans, as a rule, do not cover cosmetic procedures because they are not considered medically necessary. However, anyone who is missing teeth knows that replacing them is critical to their oral health.
Covering your dental implant procedure may require using both medical and dental coverage, depending on the reason you need them. Review your insurance policy to determine if dental implants are addressed in the materials you were given when you started the policy. Before getting any procedure, it’s important to ask your insurance provider-specific questions to ensure there are no surprises:
- Does the plan cover implants?
- What percentage of the procedure does the policy cover?
- What is my annual maximum out-of-pocket cost?
- Do I need a referral before receiving dental implants?
The staff at your dentist’s office will be able to work directly with the insurance company to determine your coverage based on the treatment plan.
Are Implants Covered By My Insurance?
To determine whether your insurance covers implants, it’s important to know the different parts of the treatment and how much mouth preparation is needed. The amount of coverage also depends on whether you are receiving a full arch of restored teeth or just replacing one or two missing teeth.
Tooth Extraction: Depending on whether you are already missing teeth or if the tooth needs to be extracted, this procedure will be part of your dental implant treatment. Most insurance companies cover all or most of tooth extraction.
Bone Grafting: Some patients need their underlying jawbone strengthened prior to the implant procedure to ensure the implant will stay in place. This part of the procedure may not be covered, despite it being a crucial step in the implant procedure.
Placing the Implant: The implant placement procedure is considered a “major” dental procedure. Don’t be anxious about the use of the word “major,” though — this is a term insurance companies use that does not always reflect the intensity of treatment. Some plans cover up to 50 percent of major procedures.
Placing the Artificial Tooth: The artificial tooth — crown — that is mounted atop the implant provides the appearance and functionality of natural teeth. This part of the procedure is also considered “major”. Some plans consider this the same as crowning a natural tooth and may cover more of the cost, so check directly with your insurance company.
Dental Implants in Plano, TX
We understand that working with insurance and a budget can get confusing. The Sensational Smiles staff will work with you, your dentist, and your insurance company to offer you the best treatment based on your needs and budget — and a long-lasting smile. Schedule your complimentary consultation with Dr. Sowell online or call (972) 382-6855 today.