What Insurance Covers Dental Implants – Health insurance and dental coverage can be confusing, especially when it comes to coverage of specialty dental procedures like dental implants. Many of our patients ask us if their dental insurance will cover dental implants, and the answer is that it depends on your insurance and the type of implant treatment you are receiving. Dr. Mark Sowell of Sensational Smiles in Plano, TX will work with you and your insurance company to create a treatment plan that fits your needs and budget.
Many insurance companies consider dental implants a purely cosmetic procedure, and therefore not medically necessary. Most dental insurance plans, as a rule, do not cover cosmetic procedures because they are not considered medically necessary. However, anyone who is missing teeth knows that replacing them is critical to their oral health.
What Insurance Covers Dental Implants
Covering your dental implant procedure may require using both medical and dental coverage, depending on the reason you need them. Review your insurance policy to determine if dental implants are addressed in the materials you were given when you started the policy. Before you get any procedure, it’s important to ask your insurance provider specific questions to ensure there are no surprises:
Dental Implants And Care
The staff at your dentist’s office will be able to work directly with the insurance company to determine your coverage based on the treatment plan.
To determine whether your insurance covers implants, it is important to know the different parts of the treatment and how much oral preparation is needed. The amount of coverage also depends on whether you are getting a full set of healthy teeth or just replacing one or two missing teeth.
Tooth Extraction: Depending on whether you are already missing teeth or if the tooth needs to be extracted, this procedure will be part of your dental implant treatment. Most insurance companies cover all or most of tooth extraction.
Bone grafting: Some patients need their underlying jaw bone strengthened before the implant procedure to ensure that the implant will stay in place. This part of the procedure cannot be covered, even though it is a critical step in the implant procedure.
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Placing the implant: The implant placement procedure is considered a “major” dental procedure. Do not be worried about the use of the word “main,” though – this is a term insurance companies use that does not always reflect the intensity of treatment. Some plans cover up to 50 percent of major procedures.
Placing the artificial tooth: The artificial tooth – crown – which is mounted on top of the implant gives the appearance and functionality of natural teeth. This part of the procedure is also considered “main”. Some plans consider this the same as crowning a natural tooth and may cover more of the cost, so check directly with your insurance company.
We understand that working with insurance and a budget can be confusing. The Sensational Smiles staff will work with you, your dentist and your insurance company to offer you the best treatment based on your needs and budget – and a long-lasting smile. Schedule your complimentary consultation with Dr. Sowell online or call (972) 382-6855 today. Not only are they important for feeling and looking our best, but our teeth and gums also help us with socialization and clear communication with our friends and loved ones. Had ones.
Tooth decay is linked to serious illnesses such as stroke, diabetes, dementia and heart disease. Untreated tooth decay can also delay or prevent treatment for chemotherapy, organ transplants, heart valve replacement and joint replacement among others. So it’s serious stuff.
Does Dental Insurance Cover Dental Implants In Lisle?
Almost one in five adults of Medicare eligibility age (65 years of age and older) have untreated cavities. The same proportion had lost all their teeth. Half of Medicare beneficiaries have some periodontal disease or infection of structures around teeth, including the gums.
Although traditional Medicare does not include “dental insurance,” it may cover some procedures that you may not be aware of. Although original Medicare benefits under Part A and Part B do not cover routine or cosmetic dental care, there are certain cases in which oral surgery qualifies for coverage with these benefits. These circumstances usually involve a covered medical condition that requires oral surgery as part of a broader treatment plan, as is the case with extracting damaged teeth before radiation treatment or an organ transplant.
Traditional Medicare will cover dental procedures that are integral to other covered services. So if your Medicare-covered hospital procedure involved dental structures in some way important related dental care would be covered. But paying for any other care is up to the patient.3
For example, if you have a severe oral condition that threatens your overall physical health, you may be covered.
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Medicare may cover dental implants…or at least some of them. If you have a condition that, if left untreated, would impact your health and well-being, you may be eligible to have part of your costs covered by Medicare. In general, only severe oral health conditions that threaten your overall physical health are considered medically necessary procedures. These conditions may include: dental infection that is threatening your physical health and increasing your risk for heart disease, heart attack, stroke, pulmonary (lung) infection or blood clots gastroesophageal reflux or other stomach issues that result from a poor diet inability to chew or Consume healthy foods Cysts or abscesses in the bone Difficulty chewing food due to pain and lack of teeth 4
But just because Medicare agrees that you have a covered condition, you’ll still have significant costs that Medicare won’t cover.
Even if Medicare determines that you have a condition requiring medical intervention, you will still be responsible for the remaining costs of treatment. While Medicare will not cover all of the fees needed for treatment under specific conditions, 30-50 percent of your costs may be paid. This can translate to having up to $10,000 off your oral surgery treatment. First, if the damaged tooth is still in its socket, the dentist will extract it. If the oral surgeon recommends a bone graft procedure due to lack of adequate bone mass, this will be done first. The jaw will need time to heal afterwards. The jawbone may take about three to six months to heal and be ready for the final stage of the implantation. If the jawbone is not strong enough, the implant will inevitably fail, so patience is vital during treatment. Once the bone heals, the implant will be inserted into the jawbone. During the osseointegration process, the dentist will provide a temporary restoration to preserve the tooth’s appearance. After healing and osseointegration, the dentist will attach the abutment. This piece connects to dental implants and holds the artificial restoration. The procedure is minor and usually performed under local anesthesia. The surgeon can choose to install it immediately after placing the implant or to plan a second procedure for placement. Placing the abutment requires reopening the gums to expose the implants. The gum tissue will be stitched around the abutment and given one or two weeks to heal. After the gums have healed sufficiently, the dentist will take new impressions of the mouth and existing teeth to create the new prosthetic tooth or crown for the implant.
It depends on what the surgeon is doing, and whether he or she is a Medicare-approved provider. Some procedures that are not normally covered may be covered if there are other procedures at the same time.
How To Get Dental Implants Covered By Insurance
For example, the reconstruction of a ridge is primarily to prepare the mouth for dentures is a non-covered procedure. However, when the reconstruction of a ridge is performed as a result of, and at the same time, the surgical removal of a tumor (for purposes other than dental), the totality of surgical procedures is a covered service. Likewise, the wiring of teeth is a covered service when it is performed in connection with the reduction of a jaw fracture if the reduction and wiring are performed by the same practitioner.
In 1990, the American Dental Association’s House of Delegates adopted the following comprehensive definition of medically necessary dental services: the reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances, and devices) as determined and prescribed By qualified, appropriate health care providers in treating any condition, illness, disease, injury or birth developmental malformations. Care is medically necessary for the purpose of controlling or eliminating infection, pain and disease; and restoring facial disfigurement, or function necessary for speech, swallowing or chewing.
When asked if Medicare will cover a particular procedure such as dental implants, I really can’t answer that. This is because it is not always easy to determine if a procedure will be covered by Medicare. The types of procedures depend on the needs of the patient. Whether it will be covered can only be determined by a dentist who is a Medicare provider. So Does Medicare Cover Dental Implants? Maybe. You will need to speak with a Medicare-approved dental surgeon
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