When people have missing or severely cracked teeth and would want get to dental implants, it could genuinely be to improve oral health. However, not all insurance providers see it that way, and so it’s usually challenging to have your medical insurance cover dental implants.
Your insurance provider may only be able to cover your implants if they are a medical necessity. Let’s talk about it.
What Does Your Medical Insurance Cover?
First, you should know that medical insurance and dental insurance are different. While both are types of health insurance, they cover distinct aspects of your health.
Dental insurance specifically deals with oral health, including check-ups, cleanings, fillings, and more complex procedures like orthodontics. It’s quite easier to see dental insurance packages that cover implants. But even so, the providers may only cover up to 50% or less of the cost.
On the other hand, it is quite rare to see medical insurance packages that explicitly cover dental implants.
Medical insurance covers a wide range of medical services, including doctor visits, hospital stays, surgeries, prescription drugs, and mental health services. Premiums are generally higher due to the extensive coverage – that wouldn’t expressly include implants because most insurance companies consider them purely cosmetic.
Are Dental Implants Cosmetic or Functional?
The perception that dental implants are cosmetic is why medical insurance providers would not want to cover the cost.
The line between cosmetic and functional dentistry can be blurry, especially when it comes to tooth replacement via implants. While replacing a tooth undoubtedly improves oral health by preventing complications like bite issues, bone loss, and gum disease, it also has a significant impact on appearance and self-esteem.
So, a dental implant is often a combination of both. However, many insurance companies err on the side of caution and consider it a cosmetic procedure. However, there are exceptions that could enable you to get dental implants covered by medical insurance.
Also read: Is Dental Bonding Covered by Insurance?
How to Get Dental Implants Covered by Medical Insurance
While the standard is for dental insurance to cover dental implants and medical insurance to cover medical procedures, there are instances where overlap occurs. Some medical insurance plans might cover dental implants if they are medically necessary due to an accident, injury, or underlying medical condition.
To increase your chances of getting dental implants covered by medical insurance, consider the following:
1. Document Medical Necessity
- Comprehensive Dental Exam: Obtain a detailed dental exam that clearly outlines how the missing teeth are impacting your overall health.
- Medical Records: Gather medical records to support any underlying health conditions that could be exacerbated by tooth loss.
- Consult with a Specialist: Seek the opinion of an oral surgeon or periodontist who can provide a comprehensive evaluation and documentation of the need for dental implants.
You need to prove/establish that the procedure is medically necessary rather than solely cosmetic. That is the cornerstone to building your case and having your dental implants covered by medical insurance providers.
Your dentist should thoroughly assess the impact of missing teeth on your overall health by checking if it affects your ability to eat and digest food properly, changes in your speech patterns, jawbone deterioration, and also bite alignment.
Severe jawbone loss due to missing teeth can lead to facial collapse, affecting chewing, speech, and overall oral function. This can be a strong argument for medical necessity. In some cases, impacted wisdom teeth or orthodontic treatment may necessitate the removal of teeth, and replacing them with implants could be considered medically necessary to restore oral function.
If you have underlying health conditions, you may also want to include them in the records. Certain medical conditions can increase the likelihood of medical insurance coverage for dental implants. Conditions like diabetes, heart disease, and osteoporosis can affect oral health and may justify the procedure as medically necessary.
You can always consult an oral surgeon or periodontist to provide an expert evaluation that supports the medical necessity of your dental implants.
2. Consider Alternative Financing Options
- Dental Savings Plans: These plans offer discounts on dental procedures, including implants.
- Health Savings Accounts (HSAs): If eligible, use HSA funds to cover dental implant costs.
- Low-Interest Financing: Some dental practices offer financing plans with affordable monthly payments.
Dental implants are quite expensive, which is also why most insurance providers tend to shy away from them. The cost varies but a single implant can range between $1,500 to $4,500. In the case where insurance doesn’t fully cover the cost, you may want to consider other viable financing options, which include Dental Savings Plans, Health Savings Accounts, and Low-Interest Financing.
Dental Savings Plans function similarly to discount memberships. By enrolling in a Dental Savings Plan, you gain access to reduced rates on a variety of dental procedures, including implants. While they don’t offer comprehensive coverage like insurance, they can help offset the overall cost.
But if you have a high-deductible health insurance plan, you might be eligible for a Health Savings Account. Contributions to an HSA are tax-deductible, and the funds can be used for qualified medical expenses, including dental implants, thereby providing a tax-advantaged way to save for dental care.
Many dental practices also offer financing plans to help patients manage the cost of dental implants. These plans often feature low interest rates or interest-free periods, allowing you to spread the cost over time. These plans can also be helpful.
Flexible Spending Accounts (FSAs) and Health Reimbursement Accounts (HRAs) are other financial options that can cover spending on dental implants, according to Forbes.
FSAs are employer-sponsored accounts that allow employees to set aside pre-tax income to cover qualified medical and dental expenses. Contributions are deducted from your paycheck before taxes, reducing your taxable income and lowering your tax bill.
The funds in FSAs can be used for a variety of qualified medical and dental expenses, including deductibles, copayments, coinsurance, prescriptions, and some over-the-counter medications.
The maximum contribution limit for FSAs in 2024 is $3,200, increased by $150 from 2023. This limit applies to individual contributions, and married couples participating in separate FSAs through their employers can each contribute up to the maximum. The funds are typically forfeited at the end of the plan year, although some employers offer grace periods or allow a limited amount of funds to be carried over to the next year.
Meanwhile, HRAs are employer-funded accounts that employers use to reimburse employees for qualified medical expenses. Unlike FSAs, employees typically don’t contribute their own money to an HRA. Instead, the employer allocates a specific amount of money to the employee’s HRA each year.
Summary
Dental implants offer a fantastic solution for missing or damaged teeth, but the high cost can be a barrier. In this article, we explored the possibility of how to get dental implants covered by medical insurance, even though it’s typically not the norm.
Medical insurance prioritizes medically necessary procedures. Since some view dental implants as primarily cosmetic, getting them covered can be tough. However, there are situations where medical insurance might step in. The key lies in proving medical necessity.
However, if it is not fully covered, exploring alternative financing options can help manage the cost.
We strongly encourage you to schedule a consultation with your dentists to discuss your specific situation and explore all available options. They can guide you through the insurance process, recommend financing solutions, and create a personalized treatment plan to restore your oral health and confidence.
