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More frequently than not, dental insurance per se is not an indemnity policy; in that sense it differs from a major medical policy in the way that it functions. Instead, it pays a fixed sum for stated services by a dentist who participates in its plan.

However, in situations where, for example, reconstructive surgery is medically necessary due to an occurrence, and implants are a part of the reconstruction, a major medical policy may pay for the implants. Naturally, any payment would be subject to the terms and conditions of the policy, including deductibles and copayments.

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โˆ™ 2014-10-22 22:11:14
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โˆ™ 2011-12-06 17:43:15

An increasing number of dental insurance plans are adding coverage for implants. Press releases from some of the companies announcing the coverage are available on the website of the National Association of Dental Plans in the News Section under Member News Releases. That site also has a directory of dental plans that can be searched by state. (See the related links.)

Applicable definitions that might help to determine coverage in a particular circumstance include these:

  • Implant: A support for a bridge or denture that has been surgically placed into bone
  • Bridges: Non-removable tooth replacements attached to adjoining natural teeth when one or a few teeth are missing.
  • Dentures: Removable artificial teeth in a plastic base that rests directly on the gums. A denture may be complete or partial depending on the number of missing natural teeth.

An analysis of your dental insurance contract or plan is necessary to answer the question definitively. There may be an express inclusion of implants, or an express exclusion of them; in either of those cases the answer is easier to determine than if the contract or plan relies upon the concept of "medical/dental necessity". There, reasonable minds can differ, with the countervailing argument being that an implant is cosmetic in nature. Cosmetic procedures are nearly always excluded, at least without an accompanying medical/dental procedure is "medically/dentally necessary" and that necessitates an accompanying cosmetic procedure.

If, instead of dental insurance (which is an indemnity product), you have or would be willing to purchase a discount plan, you may have a better chance of "coverage" for implants (because there is often a less strict, or no distinction between medically necessary and cosmetic procedures). I hesitate to use the word "coverage" because a discount plan does not assume risk as genuine insurance does. Instead, membership in such a plan gives a consumer access to practitioners who have agreed to extend discounts from "retail" to participants for a menu of services. Important to understand is that the consumer remains fully responsible for the payment of charges, plus the cost of membership in the plan. If you have such a plan, or are going to go this route, you also need to make sure that the selected provider continues to participate in the plan at the time that you commence services, and that the promised discount is what you receive.

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Q: Does any dental insurance cover implants?
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