Are Dental Implants Covered by Insurance? History and Hidden Truths

If you’re considering dental implants, you might be wondering if your insurance will help cover the costs. Dental implants are one of the most effective long-term solutions for missing teeth, offering durability, function, and an aesthetic match to natural teeth. However, dental implants can be a significant financial investment, and understanding insurance coverage is essential as you explore your options.

Insurance companies, often occupying the tallest building in large cities, are in the business of collecting premiums, not paying them out. United Health Care has a market cap of $515 billion, which is more than double the entire GDP of countries like New Zealand, Greece, and Portugal.

The History of Dental Insurance

To fully understand how dental insurance works, knowing the history of how it started is important. Dental insurance in the United States began in 1954 through union bargaining by dock workers in California, Oregon, and Washington. Unlike health insurance and critical medical care, dental insurance was created and “negotiated “as a fringe benefit instead of a necessity like medical insurance. Even then, it was never meant to cover all costs associated with the most complex dental procedures.  It was looked at as an added bonus to the union employees' compensation and benefits package.

When it was created, the average annual maximum coverage was around $1,000 to $1,500 per person—a limit that has unfortunately remained unchanged over 70 years. If this coverage had kept up with inflation, it would cover over $10,000 in dental care per family member today. While premiums have risen, annual maximums have remained stagnant, often leaving patients with substantial out-of-pocket costs.

As medical insurance costs rise, many employers have scaled back dental benefits, and newer dental plans may come with waiting periods of six to twelve months before coverage begins. This structure ensures that insurance companies collect premiums well before paying out for procedures, adding further limitations to already minimal coverage. Although helpful, dental insurance was never meant to cover the entire cost of dental care.  

The Difference Between Dental Insurance and Medical Insurance

Many patients new to dental insurance are surprised to discover how it differs from health insurance in cost limits and coverage. Here are some key distinctions:

• Annual Maximums: Unlike health insurance, which generally has no cap on yearly coverage, dental insurance usually has a low annual maximum—typically between $1,000 and $2,000. Once this maximum is reached, you are responsible for additional expenses. Health insurance, in contrast, has an “out-of-pocket maximum,” so after reaching that limit, insurance covers the rest of your medical costs for the year.
• Purpose and Design: Dental insurance primarily covers routine or preventive care, such as cleanings, exams, and minor procedures. Because it is not designed for high-cost treatments, premiums are significantly lower than those for health insurance. Health insurance, however, covers a broad spectrum of care, including emergency and major procedures, resulting in higher premiums.
• Coverage for Major Procedures: For major treatments like dental implants, dental insurance often covers only a small percentage or none at all, whereas health insurance is more likely to cover substantial portions of significant medical procedures once deductibles are met.
• Monthly Premiums: Dental insurance premiums are generally more affordable, often ranging from $15 to $50 per month, due to limited coverage. Health insurance premiums are considerably higher—typically hundreds to thousands of dollars per month—reflecting broader coverage and higher benefit limits.

These differences can catch patients off guard, especially when facing costly procedures like dental implants. For instance, one patient shared their experience with us, learning that after reaching their annual maximum, they had to cover the remaining costs out of pocket—an unexpected and often challenging expense. They had no idea there was an annual maximum, as they just assumed because it was called dental “insurance,” that it was just like their health “insurance”.

Understanding Dental Insurance Coverage for Implants

Most dental insurance plans today offer some level of coverage for dental implants, but it’s important to understand the limitations. Unlike medical insurance, which often has higher benefit limits, dental insurance typically has a low annual maximum—usually $1,000 to $2,000. This limit can cover only a small portion of an implant procedure, which often involves multiple stages, including extractions, bone grafting, implant placement, and crown restoration.

While some plans may cover specific components of the implant process, it’s unlikely that they will cover the entire cost. Additionally, dental insurance tends to focus on basic and preventive care, so coverage for complex treatments like implants is often limited or requires partial reimbursement at best.

Financing Options for Dental Implants

Since dental insurance is often inadequate, many patients have been forced to look for alternative ways to come up with the money for expensive dental procedures.  Third-party financing companies have stepped in over the years to try and help fill the gap. Most people have heard of Care Credit, which has been offering dental financing since 1987, but you might not have heard of some of the other financing companies, such as Proceed, Cherry, or Alphaeon. There are dental financing companies for most all credit types now, with terms extending out past 10 years in some cases, which can mean low payments for the more expensive procedures.

Flexible financing through reputable third-party lenders allows patients to pay for care in manageable monthly payments, making high-quality implant procedures more accessible. Most dental offices still only accept Care Credit, so if you are looking to finance your dental procedure, make sure you find an office that offers multiple financing options.

Why Your Decision Shouldn’t Be Based on Insurance Coverage Alone

While it’s natural to want to use insurance to offset costs, focusing primarily on insurance acceptance could limit your options and potentially compromise the quality of your care. Dental implants are a long-term investment in your oral health, so it’s crucial to prioritize the quality of materials, the expertise of your dental team, and the precision of the process to ensure lasting success and satisfaction. Always ask your dental office, even if they are not in-network with your insurance provider, if they will help make sure you have the paperwork to file your own claim. In cases like this, the patient can go to the office and dentist of their choice, submit their own claim to their insurance company, and then get reimbursed directly by the insurance company.

The Florida Dental Implant Institute: Experts in Implant Dentistry

At the Florida Dental Implant Institute, we understand the importance of high-quality, specialized care for dental implants and oral surgery. With over 50 years of combined experience, our team provides advanced implant solutions for even the most complex cases, managing every aspect of the process in-house for a seamless experience. Serving patients from Naples, Marco Island, Bonita Springs, Fort Myers, Cape Coral, and Lehigh Acres, our clinic is trusted by patients for our expertise and commitment to excellence.

We prioritize patient care and accessibility by offering various financing options, allowing you to comfortably manage costs while receiving top-tier treatment. Since we are unrestricted providers, we will also help make sure you have the paperwork required to submit your own claim for direct reimbursement by your insurance company. Insurance does not dictate our treatment, and we customize options and approaches for you to consider. We will work with you to maximize your insurance as it generally only covers basic benefits.

If you’re considering dental implants, contact us to learn how we can support you in achieving your goals with a personalized approach and expert care. Let us guide you through your implant journey for a lifetime of confident, healthy smiles.