If you are missing one or more teeth, then Dr. Henry at A Smile Spa has likely talked with you about options for tooth replacement, such as dental implants. Dental implants are, by far, the most widely preferred and recommended tooth-replacement treatment option, as they provide patients with an array of benefits and advantages in terms of oral health, functionality, comfort, and appearance.  

However, dental implants and the entire treatment process can be costly, and this deters many patients from exploring implants as a viable treatment option. We encourage patients to consider dental implants and talk with our office team about options that can help work them into their dental care budgets.  

What Insurance Covers Dental Implants?

Does Dental Insurance Cover Dental Implants?

Every insurance policy is different and offers slightly different coverage. However, many policies offered by insurance providers like Delta Dental, MetLife, and more do provide some coverage for the treatment cost of getting dental implants. The amount of coverage available can depend on a variety of factors including the specific insurance plan the patient purchases and whether or not the patient has met their annual deductible.  

Does Health Insurance Cover Dental Implants?

Sometimes, general health insurance will provide some coverage for dental implants in particular cases when dental implants are deemed medically necessary. For example, some situations when health insurance might provide coverage for dental implants include:

• A serious injury or accident impacts the head, mouth, and teeth.

• A medical condition (such as oral cancer) leads to the loss of teeth.

Does Medicaid Cover Dental Implants?

In North Carolina, Medicaid covers a variety of dental care services and treatments. Unfortunately, it does not cover the cost of dental implants because it does not accept them as medically necessary.  

Tips on Understanding Insurance for Dental Implants: What Kind of Coverage Can You Expect?

Know Your Policy and Talk With Your Provider

Coverage for dental implants varies greatly between different insurance companies and policies. To determine what kind of coverage you can expect from your insurance provider, you should review your insurance policies closely. You should also contact your insurance company to better understand the details of your policy and the circumstances (if any) when dental implant coverage would be included. Ask about any documents that are needed, the anticipated costs, and how much coverage you can expect.

Understand Your Deductible

Most insurance policies have a deductible, an amount that patients need to pay out of pocket before certain types of coverage are available on the policy. This might mean that you need to pay the amount of your deductible (which can be several thousand dollars) before your insurance provider will begin covering the cost of dental implant treatment.

Waiting Periods

Some dental insurance policies also require waiting periods before patients can begin treatment or access insurance benefits.  

Request Pre-Authorization

Some insurance companies require patients to undergo a pre-authorization process that will include filling out forms and obtaining documentation from your healthcare provider before they will approve insurance coverage on dental implants. You should ask your insurance provider if they require pre-authorization before deciding on a treatment plan.  

Prove Medical Necessity

Medical necessity is essential to insurance coverage, and proving that dental implants are medically necessary can help you get some coverage from your insurance providers. Proof of medical necessity requires a letter from a dentist, oral surgeon, or doctor that explains why implants are necessary for your health - and not an elective, cosmetic procedure.  

Make Sure Your Case Is Not an Exclusion

Some insurance policies include exclusions (i.e. cases where they would not provide coverage due to extenuating circumstances). For example, some insurance providers will not cover dental implants if they are needed as a result of a pre-existing condition, like a tooth that was missing before the dental insurance policy was purchased.  

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)

Some insurance policies (typically those with high deductibles) allow patients to use HSA or FSA accounts. These are special savings accounts where patients can save a certain amount of pre-tax money each year. (It's important to remember that HSAs and FSAs have different rules about "using or losing" your money at the end of the fiscal period.) If you have a high-deductible insurance policy that includes an HSA or FSA, then you can use funds saved in these accounts to cover the cost of dental implants.

Although money from these types of accounts is your own money that you have saved (in other words, it's not insurance coverage), using these accounts does make it possible for patients to save some money on their tax bills at the end of the year.  

Financial Consultations at A Smile Spa: We're Here to Help You Navigate Every Aspect of Your Dental Care

At A Smile Spa, we accept a wide variety of dental insurance policies and will file claims with providers both in and out of our network. (In-network insurance providers include Aetna, Delta Dental, Metlife, United Concordia, and Veterans Affairs.) We strive to provide the best possible care to all of our patients, and we understand that this also means working with our patients to make dental care financially feasible.  

Our office team is here for you. We can work with you to help you understand your estimated dental care costs and your insurance policy's coverage and to provide your insurance company with the necessary documentation. If you have any questions about the costs associated with your recommended treatment plan and payment options, we welcome you to contact us for additional information. We will be happy to answer your questions while providing you with options that work for your dental care budget.

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