Dental Implants Covered by Insurance?

George, a patient, asks us:
I’d like to know if it is possible to have medical insurance cover dental implant procedures? If not, what are the  reasons why insurance would not cover dental implants?

I had a bone graft done and the bone graft was 100% covered by  medical insurance. But the dental implants I’m getting will supposedly not be covered by insurance. Logically the dental implants are the final step in the bone graft procedure, somewhat like pins placed in a broken bone. The implants will keep the bone healthy and stable, maintain my facial structure, allow me to keep up a healthy
mouth which supports healthy nutrition. Shouldn’t it be in the financial interests of dentists and surgeons to lobby to get dental implant procedures covered? Thanks for any comments.

36 thoughts on “Dental Implants Covered by Insurance?

  1. Dear George,

    As a practicing clinician, I certainly do sympathize with your concerns of dental implant treatment being covered by dental insurance. The cost of implant treatment is certainly not a decision made without financial consideration.

    You asked “I’d like to know if it is possible to have medical insurance cover dental implant procedures? If not, what are the reasons why insurance would not cover dental implants?”

    Dental implant placement is a procedure which replaces a tooth, which in essence is a DENTAL procedure not a MEDICAL procedure. If the tooth was lost due to an accident or traumatic event like a car collision or tumor, the reconstruction may include implants where the medical insurance may provide coverage. Therefore in the vast majority of cases, medical insurance will not cover a dental procedure. Loosing a tooth from an abscess or decay is a dental problem not a medical problem, and also will be denied for claim since it is of dental origin. For an rough analogy, its like asking your auto insurance to pay for damages to your house from a fire.

    You asked “Shouldn’t it be in the financial interests of dentists and surgeons to lobby to get dental implant procedures covered? Thanks for any comments.”

    You are exactly right in saying loss of teeth does change your facial bone contour and density over time and having an implant will provide more bone preservation and a healthier life in general, but for every patient that can reasonably justify implant placement for their health, there are about 100 more people without any teeth that have managed to survive by keeping up their nutrition… with dentures. Why do I point this out? Therefore in an insurance model which chooses to provide the most cost-efficient treatment to its insured, you will not get the best treatment covered UNDER insurance. The dental insurance company is a business model concerned with making a profit (I’m sorry but its the truth), not necessary in the business for your optimal health.

    Eventually, the dental implant will become an accepted standard of care where the insurance companies will pick up coverage on them, but because of the high price tag for now, it remains an non-covered benefit. You can either decide, to accept the decision of the insurance company of how to choose a treatment plan, based solely on their coverage.

    • I don’t disagree with your comments. Your oral health is part of your oral health, if you have tooth decay it can leave bacteria that can lead to health problems such as heart problems. As for the insurance comment about the auto coverage covering your house. If the house was parted in your garage and caused the fire yes it would cover the fire damage to the house. So if your teeth are causing medical issues than yes your medical should cover your dental issues. We need our teeth to eat to keep us healthy. We need to fight for a change in these coverages.

  2. I agree with all of the above comments except for the auto insurance vs home insurance analogy. The oral cavity is part of the human body, but unfortunately, there has been an artificial dichotomy between medical and dental care as well as medical and dental insurance coverage. For example, I may have a patient who has a large cystic lesion in their mandible that has eroded bone as well as tooth structure. Upon the lesion’s removal, a tooth or teeth may be necessary to be removed to obtain complete healing. Most medical insurances will cover the cost of the lesion removal (21046 CPT) but they will not cover the cost of the removal of the associated tooth or the other involved teeth in the area. It is pure stupidity, but it is the reality of the stranglehold that the insurance companies have on providing coverage to their whim. It is more like your auto insurance pays for all repairs on your car except for the radiator cooling system, which is part of the car’s function but is determined to be an arbitrary non-covered expense. You would need to get coolant system coverage for that portion of your car. Your oral cavity is certainly part of the GI tract of your body, but it is pretty much ignored by medical insurance coverage.

  3. You would have been beter off if the Doctor who placed the bone grafts included the cost of the dental implants. Insurance companies pay for procedures that pay for. There is no regulation on what procedures they cover unless they are challenged legally as they were with Teompormandibular disorders. The problem with the Dentist is that they are unable to collectively challenge the biased changes in insurance coverage. ie: 1. The yearly maximum on dental insurance is $500-$2500- unlimited. Ortodontic coverage is certainly not evidenced based, Pre-existing conditions for crown and bridge is in the benefit of the insurance company, Down coding from crowns to amalgams. It is quite clear who sets these limitations on our patients. Dentist are better off becoming insurance companies because they are less regulated. Good luck with your implants.

  4. This discussion needs to being with the golden rule of insurance. Insurance be it medical dental or auto(PIP) is nothing more than a contract between an insurance carrier or TPA and the person whom makes the insurance purchase( most times someone in the HR department of a company). I have experience with medical, dental and PIP paying for both the bone grafting procedure and the implant placement. some plans will do so, others do not. You can appeal the claims, but the coverage is the contracted coverage. To add the fee of the implant into the bone graft has the appearance of insurance fraud.

    There is no debate about the overall dental/medical benefit to this type of treatment. However that is another and totally seperate issue.

  5. Is it true that the reason
    dental insurance and medical insurance does not cover implants is because they are not recognized the American Dental Association? I cannot afford having one without the help from insurance and if something should go wrong and the implant needs to be surgically removed what do I do?

  6. Samuel Schmidt: go look under New topics at this site “DEntal Implant Removal” and see all the information that is provided to a patient asking for information regarding implant removal. Very informative..

  7. This was my question and thanks for these well-thought out responses. A question like that is always a “Well it depends” but these were all useful points.

    I especially like the dentist who point out the “artifical dichotomy” of dental and medical health. How true. With studies showing tentative links between gum disease and heart disease, it is surely unfortunate that insurance companies are involved in deciding via coverage what is and what isn’t medically necessary, and unfortunate that dental and medical are usually considered separately. At times it’s Kafkaesque. And the analogy to the auto insurer paying for some but not all of repair – somewhat arbitrarily – is what I’m facing. It’s good to hear that there is a slight chance I can get my grill fixed and covered after all (pun intended). As with some facial plastic surgery, implants certainly can be viewed as a vanity treatment, but they should also be viewed as the correct medical choices in certain cases, especially with younger patients who have lost teeth and related bone due to trauma.

  8. I am an attractive, disabled but healthy, 64 year old, living in California.

    Having Medicare and MediCal and an income of only 10,000 a year. I am now faced with needed my four front, capped teeth, replaced with implants. One tooth has just broken off at the gum line four days ago (leaving the root behind).

    A dentist offered to implant the one broken off tooth, for 5,000. But said, the same thing is soon going to happen to the other 3 front theeth, since they are “leaking”. She offered to do all four implants for 20,000.

    I’ve always taken pride in both my appearance (which one’s teeth are a major part) and never going into debt. (My credit bal is zero with a credit line of 5,000).

    Since implants are not covered by my insurances, I’m thinking of have it done in Mexico. But I have no idea if this is adviable and the very thought of all that expensive traveling back and forth may be more than I can handle. (Can we even travel to Mexico these day?)

    Any alternative suggestions would be greatly appreciated. Kathy

  9. Four year ago my then 18 year old son lost 1/3rd of his upper right maxilla due to an ameloblastoma tumor – along with 4 teeth. That was certainly a medical situation and the replacement of those teeth should be covered by our medical insurance. He recently had an Infuse bone graft to reconstruct his maxilla. If that succeeds, we are definitely pursuing coverage for implants and replacement crowns through our medical insurance.

    When this same son was 11 years old, he lost four top front teeth and his upper front maxilla in a bike accident involving an automobile. The jaw was too fragmented to wire together – all the surgeon could do is remove pieces of shattered bone.

    Our car insurance has paid for all the surgeries, bone grafts, implants, etc for the past 11 years and will continue to cover him until the limits of our medical coverage are reached. Fortunately, we had $100,000 medical coverage so he should be covered for life on his front implants.

    Due to two traumas, covered by two different insurance policies, we have had some interesting experiences in getting payment. Seven years after the bike accident, when my son was fully grown, the ameloblastoma was discovered during preparation for the front jaw reconstruction. The tumor was removed during the same surgery in which the front maxilla was reconstructed utilizing bone from my son’s lower jaw. The auto insurance paid for the jaw reconstruction; the medical insurance paid for the removal of the tumor. The medical insurance also paid for the later radical surgery which became necessary when we discovered that the “cyst” was an ameloblastoma….but didn’t want to pay for the anesthesia because it was a “dental” procedure. Ha!….they did end up paying but I had to appeal their initial decision.

    I don’t know what battles lie ahead with regard to the implants to replace the teeth lost due to the tumor but I expect there will be some. However, due to the fact that the teeth were lost for a medical, not dental, reason I have fairly optimistic expectations that the medical insurance will cover them. Time will tell.

    I think that eventually, the implants will cost less. It will be like other things, once everyone starts getting them (and that seems to be the case more and more), ways will be found to provide service less expensively as the implant materials are manufactured in more volume and more doctors become skilled in the placement of them.

  10. George, how did you get the bone graft covered by medical insurance? My son is having a bone graft procedure done in preparation for 6 implants and they are telling me that the bone graft will not be covered. They are estiamting the bone graft to be 20-25K out of pocket. Ouch!

  11. Hi George,

    Under what circumstances will an insurance company pay for bone grafting? Must you have a a medical doctor either recommend or perform this surgery instead of an oral surgeon in order to have this procedure covered?

    Thanks,
    Di

  12. Insurance companies are still paying for bone grafts for bony defects around periodontally involved teeth. We have been unsuccessful in having them pay for bone grafts for ridge augmentation, socket preservation etc which in my opinion have much better success than those for periodontal defects. A number of companies are now helping pay for implants.

  13. 20-25K for bone grafts? Does this include the implants? I had 9 bone grafts done 2 weeks ago and they were only 3000.00 for all 9. I just found out that this has to be coordinated with my health insurance. I doubt they will pay as only 2 had complete bone loss but my dental will pay 70%

  14. Sir: I need help. My three implants are costing well over ten thousand dollars or more I have had the graphs for the three teeth but no teeth yet. I have no joint support from two TMJ surgeries. I need bone graphs for upper R area of sinus. There is only sinus area. How do I convince my medical insurance this is beyond dental insurance and medical necassary for my mental and physical health. I would like my face back. thank you.

  15. yes implants are allowed covered for BCBS, Tricare and most large insurances under your Medical Policy if: infectious disease )e.g. Oosteomyelitis 730.2 /730.18 and / or aseptic necritis) and / or if Dental Accident / injury and / or if cancer. Other oral treatments are covered if any are “opportunistic” 136.9 to any of the above and all must be medically necessary

  16. The insurance for implants is a major concern now when lots of dentists are doing implants and equally patient demands and requests for same has multiplied very much.In younger patients implants are necessary more than other options and insurance coverage shall take care of the same.

  17. The reality is this. Alot of dentist say they are involved with dental implants, when in fact they have a marginal involvement. The manufactures say there is alot of activity by Gp.s, but you have to look at this with a jaundice eye. Most GP’s do about three to four cases and get out of this service. The GP’s that are placing implants are more serious. When you look across the board, other than OMS and Perios, there are not many dentist placing implants. The AAID and ICOI should lobby for this to be covered.

  18. I agree… If a bone graft is OK for medical insurance… then why isn’t dental implants that reqiure a bone graft procedure included in the dental insurance???

  19. I had six teeth removed,bone grafting to treat an ameloblastoma in the maxilla. I had dental implants which my insurance did not cover. finally,after calls and letter from both me and my dentist they paid for the six crowns and the appliance I wore after the surgury until the implants. They stil refused payment on the implants. My advice to anyone in this situation is to keep writing and calling your ins.co.The person filing your claim must use the right codes.

  20. Implants are costly because very few dentists have the nessasary skills to perform the many proceedures nessasary for a successfull implant including techniques for gum restoration after the implant is in place and that requires a special membrane to encourage regrowth of the gum. After the gum regrowth there is also a waiting period of up to 6 months to allow the implant and bone to attach. The last phase is to add the new tooth to the implant which is also a seperate and costly proceedure. If you live near a dental school try to get the work done there by a dental student under supervision. Probably less costly.

  21. Im 29 years old im missing my uper teeth they said it would cost me 25,000.Im a mother of 3 single with no credit and going to school.Dose anyone now how I can get help? thank you, lorraine

  22. I have been diagnosed with sjogren’s syndrome and my teeth are effected so bad they are all probably going to need root canals and crowns wouldn’t it just be more reasonable to think implants would be cheaper in the long run?? I’m still young enough that I don’t like the thought of dentures. I think being able to eat without pain would benefit the patient and the insurance company from a long term standpoint.

  23. Sherry, you have my sympathies. People with Sjogrens Syndrome are just plain”screwed” so to speak. I’m thinking the current view is that this an autoimmune disorder? However unless your planning on a pregnancy maybe try pilocarpine to stimulate salivary flow. Topical florides and Biotine spray can help. I wouldn’t jump the gun and have all my teeth out. Conventional dentistry is still covered by insurance and you may still get some lengthy service from your natural teeth. I have seen patients hwo have had one tooth at a time replaced with implants, untill they get a better prosthetic design scheme, then go with some type of fixed or removable prosthesis, fixed being the more preferable route. In the future Implants will be more extensively covered by insurance. With the current success of implants a lot of heroic procedures in periodontics and endodontics just won’t be done in the future, because the statistical odds of the implant is better than some perio or endo procedures that have diminishing returns with each successive treatment/retreatment. Just my 2 cents worth.

  24. With regards to dental implants being covered by medical insurance. I am 19 years old and have been diagnosed with Amelogenesis Imperfecta Hypocalcified Type III, considered to be a genetic disorder. This causes my teeth to be severely discolored. The hypocalcified enamel of my teeth cracks and chips off very easily. There are no signs of decay on my teeth. The cracking and chipping is solely from the disorder. I have experienced pain while eating hot and cold foods for many years now, and will likely lose all my teeth in the not too distant future. Are there any insurance plans that would cover the cost of full dental implants. I understand dental insurance will not cover implants due to them being “cosmetic” but will health insurance cover it because it is required due to a disorder?

  25. Also I have been researching the All on 4 and All on 6 method of dental implants, i have heard mixed reviews on it could someone shed some light on this issue for me?

    Thank you

  26. My husband underwent surgery for oral cancer. All his lower teeth had to be removed during surgery, and they grafted bone from his leg and inserted a titanium plate to form his jawbone that was removed. He cannot have a lower denture made until he gets 4 lower front dental implants because the denture will have to be 2 pieces since his gums are uneven and would have nothing to attach to to stay in for chewing. We do not have dental insurance and medical is refusing to pay for the 4 implants. This is not a cosmetic issue…this is a health issue. He has a great deal of trouble eating with only top teeth and wear and tear on his bare gums is not a good thing with oral cancer. I can understand medical insurance companies refraining from covering some implants that are strictly cosmetic and could be remedied with a bridge or dentures. We don’t have the option of a bridge, nor do we have the ability to obtain dentures without the dental implants to hold them. To me, this should be considered a necessary prosthesis and covered under medical. If you have a cancerous leg or breast and they have to remove it, medical insurance will pay for the prosthesis. They removed jawbone but medical insurance will not cover replacing anything to anchor a denture. After last years surgeries, radiation, and HBO treatments, we are tapped out and bummed out.

  27. It doesn’t make sence to destroy 2 healty teeth to put in a fake tooth/bridge that will fail over time. When you can easily fix the problem permantly without destroing teeth.

  28. What the hell type of country do we live in where a person can’t get a needed tooth implant at an extremely low price or have it covered by insurance?

    It’s absurd that one has to leave this country to get proper affordable dental and medical work. Let’s not sit here and try to make excuses for in this thread. It must change.

  29. why is it that people who can not even eat, are losing weight and their self image is distroyed cannot be covered by insurance but people ( a few of which I know personally) can have gastric bypass surgery covered to lose weight, when they won’t exercise or watch there diet?.

  30. An array of medically necessary dental procedures can be covered by medical insurance. It really depends of the type of insurance plan as well as the degree of documentation included with the claim form. The provider needs to work closely with their office staff or biller to bill medical insurance properly.

  31. I have not read all of the above comments in full, but my immediate reaction after reading the first by Anonymous on 9/16/06 was exactly that of Dr. Margarone’s, which followed next: the distinction between “dental” and “medical” is completely fallacious and ridiculous. One’s mouth is part of one’s body, GI tract, etc. OF COURSE “dental work” is a medical procedure! Dr. Margarone’s analogy that it is like saying the radiator is not part of the rest of the car is apt. This dental/medical distinction is utterly ridiculous. Dental surgery, like other medical surgery, is surgery. It should be covered by medical insurance – or “dental plans” or “dental insurance” should be regulated to be required to provide exactly the same level of coverage that “medical insurance” does. Why else does one have any kind of insurance except to cover major expenses. There might be some grading based on how likely the risk or need for coverage is…one does not necessarily expect to have heart surgery, cancer, etc.
    Just as one does not expect necessarily, if a good driver, to have a car accident. If the dental procedures have a high to 100% likelihood of happening – e.g. many early teenagers get orthodontic braces; many 20-22 year olds get wisdom teeth removed; etc. – then maybe the % of coverage or requirement for a larger co-pay is required. But an unexpected internal resorption of a tooth (such as I have), which requires an extraction, and – as best treatment – an implant with bone grafting, is certainly a major, unexpected, uncontrollable medical expense; like having appendicitis, or breast or prostate cancer, etc. etc. There should be standard major medical insurance coverage for this and other major dental procedures.

  32. F Jessup: I see your point and do not disagree with you or others that have made post. Insurance companies are in business. The business of business is business. I am not saying this to put you down. They get me ticked off too. Maybe in the long run it’s a good thing that implants are not covered?

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