Are you finding a way to have your dental implants paid for by medical insurance? You are not alone.
Dental implants are a common option for those who want to replace missing teeth, but the process of implanting teeth is very costly.
A single-tooth implant can cost around $4,000, while a full-mouth teeth implant can cost up to $90,000.
However, there are methods available to have your dental implants paid for by medical insurance or to obtain dental grants for low-income adults.
In this article, we will explore the best medical insurance that covers dental implants, such as:
Therefore, be sure to discuss specific questions about your needs and how they relate to your insurance with your dentist and insurance provider.
What insurance covers Dental Implants ?
Dental implants have gained popularity as an effective solution for replacing lost teeth; however, their high cost often raises concerns.
People are always concerned about a common question of whether insurance policies cover dental implant expenses.
This section will explore the types of insurance that provide coverage for dental implants.
Medicaid coverage for dental implants varies from state to state. In general, Medicaid does not cover adult dental implants because dental implants considered as cosmetic procedures.
However, there are some exceptions to this rule. For instance, Medicaid may cover dental implants for children or adults with some medical condition requiring implants.
Managed Care Organizations (MCOs) handle the claims underwriting process for Medicaid under contract with the states.
To receive a final determination, submit a letter of medical necessity to the MCO listed on your member ID card.
Well-known insurance companies often operate as MCOs for Medicaid in many states, so it is understandable if you find it confusing.
Here are some examples of states that cover dental implants under Medicaid:
- New York
- New Jersey
Original Medicare (Parts A and B) usually does not cover dental implants or routine dental care.
However, Medicare may cover dental implants when they are medically necessary.
However, seniors with qualifying health conditions should ensure they send their letters and documentation to the correct organization.
Seniors with regular Medicare Parts A & B should submit their documents to the Centers for Medicare & Medicaid Services (CMS).
On the other hand, seniors with Medicare Advantage plans should direct their correspondence to the private company managing their policy, such as United Healthcare, Humana, BCBS, CVS Health, and Kaiser Permanente.
What dental insurance covers dental implants ?
Most dental insurance plans provide at least partial coverage for dental implants. The amount covered will depend on your specific plan and insurance provider.
Typically, the following types of plans usually offer the best coverage for implants:
Dental HMO (Health Maintenance Organization) plans usually cover implants at a lower out-of-pocket cost. However, you will need to use dentists within the plan’s network.
Dental PPO (Preferred Provider Organization) plans: PPO plans often cover implants, mainly if you use an in-network dentist. However, you will still pay a portion of the cost, but less than without insurance.
Private dental insurance plans: Companies like Aetna, Delta Dental, Guardian, and MetLife routinely cover implants. However, the coverage amount will depend on your chosen plan type and level.
Vision and dental discount plans: While not technically insurance, discount plans provide reduced rates on implants and other dental procedures when using dentists in the plan’s network. In this case, you pay the discounted amount in full at the time of service.
What the Plans May Cover ?
Specifically, the portion of the implant procedure covered by your insurance typically includes the following:
- Firstly, the initial consultation, diagnosis, and treatment planning.
- Secondly, placement of the dental implant fixture into the jawbone.
- Thirdly, custom abutments to connect the implant to the replacement teeth.
- Lastly, placement of a temporary crown, bridge, or denture while you heal.
The plans often do not cover the final restoration like permanent crowns, bridges or dentures attached to the implants.
Consequently, you must pay some of these costs out of pocket. However, some insurers may increase coverage if you use the same plan.
Talk to your dental insurance provider to determine your implant coverage before proceeding with any treatment.
Ask about coverage limits, out-of-pocket costs, pre-authorization requirements, and which dentists in your area is part of your plan’s network.
You can cover at least part of the cost of your dental implants with the right plan and preparation.
Does Blue Cross medical insurance cover dental implants ?
Regarding dental implants, health insurance coverage can vary significantly depending on your plan.
For example, Blue Cross Blue Shield (BCBS) insurance, one of the largest providers in the U.S., does offer coverage for dental implants for most of their plans.
To help you navigate this process, here are some tips to help get your dental implants covered under your BCBS medical insurance:
Check Your Plan Details
The first step is to log in to your BCBS account and review the details of your specific plan.
Once you log in, look for the “dental benefits” or “oral surgery” sections. Plans that cover dental implants will often list benefits for “major restorative services” or “oral surgery.”
If implants are not mentioned, you may still have coverage under medical necessity.
Call the number on your insurance card to speak with a representative and clarify your coverage.
Get a Letter of Medical Necessity
If dental implants are not an explicitly covered benefit under your plan, you can ask your dentist to provide a “letter of medical necessity.”
This letter states that dental implants are medically necessary to restore function, relieve pain, or treat a health condition like tooth loss or jawbone deterioration.
Once you have the letter, submit this letter to BCBS, who may approve an exception to cover the procedure.
Check if Sedation or Hospitalization Is Covered
Even if your plan does not cover dental implants, it may cover related services like sedation, anaesthesia or hospitalization fees.
As a result, this can offset a portion of the total cost. Discuss options for sedation and location of service with your dentist to maximize what your insurance will cover.
Consider Other Financing Options
If your BCBS plan still will not cover dental implants or only covers a portion of the cost, keep hope.
Fortunately, many dentists offer flexible financing options like interest-free payment plans, low-interest medical credit cards, and third-party financing.
Crowdfunding and personal loans are other ways to finance dental implant treatment.
To find the best option, shop around at different dentists to compare insurance coverage acceptance and financing options.
With some patience and persistence, there are paths to getting Blue Cross Blue Shield health insurance to cover dental implants, even for plans where it’s not a direct benefit.
What treatments are covered by your dental insurance?
Removing bone-impacted wisdom teeth, which can cause pain, infection, and the development of cysts, is often covered by health insurance because it is considered medically necessary.
An oral surgeon may sometimes need to extract any remaining bone-impacted teeth as a preliminary step for full-mouth restorations, such as the All-on-Four technique.
C T Scans
Your medical insurance may cover CT Scans performed by an oral surgeon or prosthodontist to measure the height and width of your jawbone.
This is important because it helps them place the appropriate dental implant and avoid nerves and sinuses.
Additionally, CT scans are considered medically necessary When your dentist suspects oral cancer and needs an image of your upper and lower jaw for a proper diagnosis.
So there you have a few tips to help increase your chances of getting dental implants covered by your medical insurance.
To maximize your chance, research, providing medical justification, and appealing denials are critical. However, while insurance companies can be frustrating, keep going.
Be persistent, and don’t take no for an answer. Your smile and oral health are worth it.
If cost is still a concern, ask your dentist about payment plans or look into dental schools in your area for lower-cost options. Remember, where there’s a will, there’s a way.
Stay positive, keep pushing forward, and before you know it, you’ll be sporting a bright new smile thanks to those dental implants you fought so hard to get covered.
The effort will be well worth it, so get out there and make it happen!
Frequently Asked Questions (FAQ)
The average lifespan of a dental implant can range from 10 to 30 years. As a result, this means that, depending on your age, when you receive an implant, it could last for the rest of your life.
Yes, dental implants are tax-deductible. This is because medical care expenses include payments for the diagnosis, cure, mitigation, treatment, or prevention of disease or payments for treatments affecting any structure or function of the body.
Dental implants are a form of oral surgery. Specifically, they are categorized by type, material, design, and attachment method.