Dental insurance can cover implants but if yours doesn't, it means that you chose a plan with no implant coverage. Every dental insurance carrier will offer different tiers of their plan with their respective monthly premiums.
The lower tiers are the least expensive but they will often not have any coverage for it. On the contrary, if you elect to pay for the more premium tier, you will most likely have implant coverage.
Can dental insurance really cover implants?
Yes, dental insurance can have implant coverage and we've personally seen it with our own patients at our dental practice. As a matter of fact, nearly all of our patients who needed the treatment did end up receiving benefits for it from their insurance, at a percentage of course.
Perhaps our patients just have better coverage than the average? Well, they all have a dental PPO insurance and not a DHMO plan. Nonetheless, we'll show you concrete proof of insurances that cover it. Seeing is believing.
Proof of coverage
It would be impossible to show you an example from every dental insurance carrier since there are so many of them. We've randomly picked two and pulled up the benefits and eligibility for random patients to show you that there is indeed coverage.
Example of delta dental covering implants at 60%:
On average, if there is coverage for implants, it is usually at 50% so this delta dental plan that covers it at 60% is considered very good. Consider yourself lucky if this is your plan.
Example of cigna PPO covering implants at 50%:
Cigna is another major carrier for dental insurance and as you can see here, there is coverage for the procedure as well! We can keep going and keep listing different insurances to show you proof of coverage but it would be redundant. This should be enough to persuade you of our argument.
Different tiers of insurance plans
All dental insurances will offer different tiers or levels of coverage. The lower level plans will usually give less coverage while the higher level plans will give more of it. Of course the caveat is that the higher tier plans will have a higher monthly insurance premium.
Essentially, you get what you pay for! If you do not have implant coverage on your plan, it simply means that you might've unknowingly chose a lower end plan. That is all there is to it.
Examples of insurance tiers
To reiterate, all insurances offer different levels of coverage in order to accommodate the different needs of their clients. Each insurance carrier will call their different offerings via different names.
Delta dental:
Deltacare USA - lowest tier
Delta PPO
Delta Premier - highest tier
MetLife dental:
DHMO/managed care - lowest
PDP
PDP Plus - highest
Cigna dental:
Cigna dental care DHMO - lowest
Cigna Advantage
DPPO - highest
We can go on and on and on listing the various carriers and their different offerings but you get the idea. The point we wish to make is that if you currently don't have coverage to replace that missing tooth with a titanium implant, you can simply upgrade your plan to a higher tier. Once you do, you should have coverage for it!
Alleged reasons for no implant coverage
There have been a lot of alleged claims floating around the internet about why dental insurance doesn't cover implants, which are all FALSE.
Alleged reasons for no coverage:
Experimental. Implants are a new procedure and is considered "experimental" which is why their coverage is being denied. That is false because this procedure has been in service for decades already.
Cosmetic. It is purely done for cosmetics to replace missing teeth, which is absolutely false. Replacing missing teeth helps you chew so while it does improve cosmetics, it improves your quality of life by chewing better.
Cost avoidance. Insurance companies don't want to pay for it since it is expensive. That is false because as we proved above, all insurances have different levels of coverage and you get what you pay for. If you don't have coverage its because you chose a low level plan with low coverage.
All of these reasons above are false in regards to why you don't have coverage. The main reason why you don't is because you purchased a plan that didn't have coverage for it to begin with. Typically if you choose a more premium plan with a higher monthly payment, it should have coverage for you to replace your missing tooth.
Takeaway
It's not that dental insurance doesn't cover implant treatment but rather you signed up for a plan that doesn't have coverage for it. While you were deciding which one to purchase, you were most likely offered different options and tiers of the plan.
The more costly higher level ones will usually have coverage for it.
The less costly lower level ones will usually not have any benefits for it.
In summary, whether or not you'll have benefits for it will all depend on how much you're willing to pay for it. If you want more benefits, you'll have to pay more per month to get it!
Our dentists in Long Island City recommend that if you're specifically looking to replace missing teeth, you should look closely at the plan's implant benefit section. If it says 0% then don't chose that plan!
