What is and is not covered by health insurance and dental can be confusing, especially when it comes to specialty procedures like dental implants. Many patients ask us whether their specific insurance covers dental implants, and the answer is that it depends on your insurance coverage, the type of implant treatment you receive and the reason you are getting it.
New Bern, NC dentist Dr. J. Stephen Hoard 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 to be merely a cosmetic procedure, and therefore not medically necessary. Most insurance plans do not cover cosmetic procedures because they have been deemed not considered medically necessary, but anyone who is living with missing or damaged teeth knows that it can be detrimental to their dental health.
Covering your dental implant procedure may require you to make use of both your medical and dental coverage, depending on the reason you need an implant. Review your insurance policy carefully to see whether there is any mention of dental implants in the materials you were given when you opened the policy. Before getting any procedure, it’s important to ask the insurance company questions about coverage to ensure there are no surprises:
- Does the plan cover implants?
- What percentage of the procedure will your policy cover?
- What is your annual maximum out-of-pocket cost?
- Will you need a referral before receiving dental implants?
The staff at Dr. Hoard’s office or your local 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 have an understanding of 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 a tooth extraction.
Bone Grafting: Some patients require their underlying jawbone to be reinforced due to gum disease prior to the implant procedure to ensure the implant will be properly supported. This part of the procedure may not be covered even though it is a crucial step in the implant procedure.
Placing the Implant: The implant placement procedure is considered a “major” dental surgery. Don’t be leary 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 that provides the appearance and functionality of natural teeth is also considered a major procedure. 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 New Bern, NC
We understand that working with insurance and while trying to stay within your budget can be challenging. Dr. Hoard and his staff will work with you, and your insurance company to offer you the best treatment based on your needs and budget — and a long-lasting, confident smile. Schedule a consultation online or call (252) 507-0373 today to discuss dental implants or any cosmetic or general dentistry need you may have.