If you are among the millions of American adults who are missing one or more teeth, you might be considering dental implants as an option. This tooth replacement solution looks, feels, and functions the most like your natural teeth. However, before you decide that you definitely want to go this route, you may be wondering about your dental insurance coverage.

For most patients at Sunnyvale Dental Center, dental coverage is the deciding factor when it comes to any dental treatment. Our friendly office staff will work with your dental insurance provider to determine your coverage during your consultation visit. We will provide you with a quote detailing your portion. We strive to make dental implants affordable and may be able to offer financing options to help.

If dental implants are deemed “medically necessary”, your dental and/or medical insurance may be willing to cover this procedure.

Common Costs Associated with Dental Implants

Chances are, you will have to pay for a portion of your dental implants out-of-pocket. On average, the estimated cost of a single dental implant is around $5,000. Of course, this depends on your personal needs, additional procedures required, your insurance coverage, and more. In order to determine what you can expect to pay, you’ll want to find out about the following:

• Your plan’s annual maximum
• Co-payments and co-insurance
• Implant procedure deductible

In addition to the above factors, you’ll also need to think about your personal treatment needs, as these will have an impact on your expected costs.

• The number of implants you need
• The type of implants used (titanium vs. zirconia)
• The number of teeth that need to be replaced
• The type of artificial teeth used (porcelain, composite resin, etc)
• The need for additional procedures including extractions, sedation dentistry, etc
• The location of the clinic
• Whether or not there are any viable alternatives

Does Dental Insurance Cover Dental Implants?

Typically, standard dental insurance plans do not cover dental implants. You will need to check your coverage to determine if this is the case for you. If so, you may want to investigate cosmetic dental coverage, which will cover a portion of this procedure. In most cases, this will cover up to 50% of the cost of the procedure. In some cases, you must pay your deductible before coverage begins.
In some cases, your medical insurance plan may cover dental implants. However, this varies depending on your policy. If you do not have dental insurance or your medical insurance does not cover implants, you may want to look into a discount dental plan membership or find a policy that does cover dental implants.

When Does Dental Insurance Cover Implants?

If you do have dental and/or medical insurance, you will want to check your coverage to determine if cosmetic dental procedures such as implants are covered. If implants are covered, you’ll want to check the following:

• Pre-existing Conditions – In some cases, dental coverage is restricted based on pre-existing conditions. You’ll want to find out if this is in your policy. If your tooth was already missing prior to your effective coverage date, the policy may not cover dental implant treatment.
• Annual Maximum – Typically, insurance providers use the calendar year to determine the annual maximum, or the amount they will cover for you and your family within the year. If you have reached your annual maximum or you are getting close to that amount, you may be responsible for paying for the full cost of treatment.