Dental implants offer an unmatched solution for missing teeth, providing long-lasting function and a natural appearance. While they are the gold standard in tooth replacement, one of the most common questions we receive is: “Are dental implants covered by insurance?” The short answer? Sometimes.
At the Texas Center for Oral Surgery, our team helps patients navigate their benefits to reduce out-of-pocket costs and get the care they need. Here’s what you should know about dental insurance coverage for dental implants.
Understand Your Dental Plan
The first step is to review your dental insurance documents to see if implants are included. Every plan is different, and some only cover implants under specific circumstances. If you’re unsure, our insurance team is happy to help interpret your policy and request benefit verification on your behalf.
Watch Out for the “Missing Tooth Clause”
Some plans exclude implants for teeth that were extracted before you enrolled in your insurance. This is known as the “Missing Tooth Clause.” It’s essential to determine whether your plan includes this exclusion so you know what to expect in terms of coverage.
What Parts of the Implant Process Are Covered?
Dental implant treatment involves several steps—and some of those may be covered even if the implant itself is not. Here’s a breakdown of common components and their typical coverage:
- Tooth Extractions: Often classified as “Basic” services. Many plans cover 60–80%.
- Bone Grafting: Not usually covered, though some plans reimburse a portion if it’s deemed medically necessary. Learn more about this step on our bone grafting page.
- Implant Placement: Considered a “Major” dental procedure. Some plans may cover up to 50%, but many exclude it entirely.
- Abutments: Often excluded, though occasionally covered under Major services.
- Implant Crowns: If your plan covers crowns on natural teeth, it may also cover implant crowns—usually up to 50%.
Timing Your Treatment for Maximum Benefits
Dental plans often include an annual maximum benefit (typically around $1,500). Smart scheduling can help you make the most of this limit. Consider placing the implant late in the year and using renewed benefits for the crown the following January—since implant treatment spans several months.
Use Pre-Tax Accounts for Additional Savings
If your dental insurance doesn’t fully cover your procedure, remember that you can use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for treatment with pre-tax dollars. These accounts can be a major advantage when planning for implant costs—just be sure to use your FSA before December 31 to avoid losing funds.
Need Help? We’re Your Insurance Advocates
Dental insurance is often confusing, but you don’t have to navigate it alone. Our administrative team works with insurance companies every day and will guide you step-by-step through coverage checks, pre-authorizations, and alternative financing.
If your plan doesn’t cover implants, we’ll explore options like financing through CareCredit—many of which offer 0% interest for qualified applicants.