Dental Implants Insurance: What Plans Cover and How to Pay

By Michael Sprague, Licensed Health Insurance Agent · Reviewed by Heather Sprague, Licensed Health Insurance Agent Dental implants insurance can help pay for one of the most costly dental procedures. Implants replace a missing tooth with a post in the jaw and a crown on top. Some dental plans now cover them as a major service, but many still limit or exclude them. So the plan you pick matters a lot. This guide explains how dental implants insurance works, what waiting periods and limits to watch for and how to plan your treatment. For the basics, see our guide to dental care coverage. Questions? Call 888-730-6031 for free help from a licensed agent.

Does Dental Insurance Cover Implants?

It depends on the plan. Older dental plans often called implants cosmetic and excluded them. Today, more plans cover implants as a major service when a tooth is missing or must be removed. But coverage varies a lot from one plan to the next. So before you buy, read the plan's list of covered services. Look for the word "implants" by name, not just "major services."

How Dental Plans Usually Pay for Implants

Most dental PPO plans group care into three tiers. Implants, when covered, fall in the top tier:

• Preventive care: Cleanings and exams, often covered at the highest level.
• Basic care: Fillings and simple extractions, covered at a middle level.
• Major care: Crowns, bridges, dentures and implants, covered at the lowest level.

So even with coverage, you'll usually pay a larger share of the cost for an implant than for a filling.

Waiting Periods for Implant Coverage

Many individual dental plans have a waiting period before major services are covered. It's often 6 to 12 months, and sometimes longer. During that time, the plan won't pay for implants even if they're listed as covered. Some plans waive the waiting period if you had dental coverage right before. If you need an implant soon, ask about that before you enroll. Need an implant and want a plan with a shorter wait? Call 888-730-6031 and a licensed agent can compare dental plans for you.

Yearly Maximums and Missing Tooth Clauses

Two plan rules often limit implant coverage:

• Annual maximum: The most the plan will pay in a year. An implant can use up most or all of it.
• Missing tooth clause: Some plans won't pay to replace a tooth that was missing before your coverage began.

If you need more than one implant, ask your dentist about spreading treatment over two plan years. That way, you can use two yearly maximums.

Is an Implant Done in Stages?

Yes. An implant usually takes several steps over a few months. That may include an exam and imaging, removing the old tooth, a bone graft, placing the post and then the crown. Your plan may cover some steps and not others. So ask your dentist for a written treatment plan with codes for each step. Then send it to your plan for a pre-treatment estimate. That shows what the plan expects to pay before you start.

Other Ways to Pay for Dental Implants

If your plan won't cover all of the cost, these options can help:

• Use HSA or FSA funds, since implants are a qualified medical expense.
• Ask about a dental discount plan, which offers reduced rates at member dentists.
• Ask your dentist about payment plans.
• Look into dental schools, which may offer care at lower cost.

A discount plan isn't insurance, but it can pair well with a dental plan that has a low yearly maximum.

Choosing a Plan if You Need Implants

If you know you'll need an implant, compare plans on these points: whether implants are named as covered, the waiting period for major care, the yearly maximum and any missing tooth clause. A plan with a higher premium but a higher maximum may pay off. Also check that your dentist is in the plan's network. Read our guides to UnitedHealthcare dental insurance and dentists that accept UnitedHealthcare to see how to check.

Implants vs Bridges vs Dentures

An implant isn't the only way to replace a tooth. A bridge uses nearby teeth for support, and dentures replace several teeth at once. Plans often cover bridges and dentures more readily than implants. The right choice depends on your mouth, your budget and your dentist's advice. Ask your dentist to compare options and send each to your plan for an estimate. Want help weighing your plan options? Call 888-730-6031 for free help from a licensed agent.

Does Medical Insurance Ever Cover Implants?

Usually not. Health plans treat implants as dental care. However, there are a few exceptions. If you lose teeth from an accident, cancer treatment or a medical condition that affects the jaw, your medical plan may cover part of the repair. Coverage in these cases depends on the plan and on clear records from your doctor. If your tooth loss is tied to an injury or illness, ask both your dental and medical plans. Sometimes they share the cost.

Steps to Take Before Your Implant

Follow these steps to avoid surprises:

• Get a full treatment plan with procedure codes from your dentist.
• Send it to your plan for a pre-treatment estimate.
• Confirm the dentist and any oral surgeon are in network.
• Check how much of your yearly maximum is left.
• Ask whether any step, such as a bone graft, is covered differently.
• Set aside HSA or FSA funds for your share.

Adding Dental Coverage Mid-Year

Unlike health plans, most stand-alone dental plans let you enroll any time of year. That means you can sign up as soon as you learn you need an implant. However, the waiting period for major care still applies, so starting early helps. If you also need health coverage, you can sometimes add a dental plan at the same time. Call 888-730-6031 and we'll help you match a dental plan to your treatment timeline. You can also read our main guide to dental insurance.

Dental implants insurance: FAQ

Does dental insurance pay for implants?

Some plans do, usually as a major service. Check the plan's list of covered services for implants by name.

Is there a waiting period for implants?

Often, yes. Many individual plans have a waiting period for major services.

Can I use my HSA for dental implants?

Yes. Dental implants are generally a qualified medical expense for HSA and FSA funds.

Next Steps for Dental implants insurance

Dental implants insurance can lower your cost, but the details decide how much it helps. Look for plans that name implants, check the waiting period and yearly maximum, and get a pre-treatment estimate before you start. Want a licensed agent to help? Call 888-730-6031, Monday through Friday, 9 a.m. to 6 p.m. Eastern, or request a free quote.

Sources

1. American Dental Association: Health Policy Institute
2. IRS Publication 502: Medical and Dental Expenses
3. HealthCare.gov: Dental coverage in the marketplace

Related Guides

• Dental care coverage
• Dental insurance
• UnitedHealthcare dental insurance
• Dentists that accept UnitedHealthcare

Vivna Insurance is a licensed independent agency, not a government website. Our help is free; we are paid by the insurance companies we work with. Coverage options, deadlines and costs vary by plan and state.