If you wonder how much dental implants cost with insurance, you have come to the right starting point.
The issuing company is the ultimate authority regarding the claims they will honor and the percentage of expenses they will cover. So they are your final destination.
However, knowing the right questions and the best moves to make before contacting your insurance company could make an enormous difference in your out-of-pocket spending.
Follow along as we break down the key issues worth understanding by comparing how various insurance plans work with single-tooth restorations versus full-mouth replacements.
Then, apply these lessons to establish a reliable budget and perhaps save some money.
Single Tooth Implant Cost
Your projected single-tooth implant cost with insurance depends on your coverage design, the expense-sharing features of your plan, and whether it covers any procedure steps.
Of course, these examples assume that your plan covers treatment – which is rarely the case.
For illustration purposes, we compare the average retail price of $3,500 in the USA for a single implant, abutment, and crown and whittle it down to $3,000, $2,500, $1,900, $1,300, and $0.
Medicaid
Under the health insurance component, Medicaid covers dental implants for adults when medically necessary (rare). However, it might pay only a tiny portion of expenses under the oral care element, which varies by state.
Therefore, a single-tooth out-of-pocket cost estimate with Medicaid breaks in two ways.
- $0 for medically necessary treatment because providers cannot balance bill
- $3,000 to $3,500 to replace teeth lost due to decay or gum disease because the least expensive treatment rule excludes most services
Medicare Advantage
Medicare does not cover dental implants for seniors enrolled in regular Parts A and B with traditional supplemental insurance (Medigap). Some Advantage plans do, but they have minuscule annual benefit limits.
Therefore, a single tooth unreimbursed cost estimate with Medicare breaks in two ways.
- $3,500 for seniors with Parts A & B with no benefits
- $2,500 for seniors with Advantage plans with limited benefits
- $500 annual maximum
- 50% copayment for restorative care
- Discounts for using an in-network provider
Health Insurance
Health insurance might cover tooth implants when medically necessary (rare). Qualifying service is “appropriate to the evaluation and treatment of a disease, condition, illness, or injury and is consistent with the applicable standard of care.”
Once again, every healthcare plan has unique expense-sharing features. For illustration purposes, assume the following.
- Deductible: $1,500
- Coinsurance: 20%
Therefore, a single tooth out-of-pocket cost estimate with health insurance is $1,900.
- Charge: $3,500
- Deductible: $1,500
- Coinsurance: $400
Dental Insurance
The cost of a single tooth implant with dental insurance depends on the policy’s exclusions, your choice of provider, and the expense-sharing features.
Policy Exclusions
The missing tooth clause in many dental plans means that most patients have no coverage for replacement teeth – including dentures. Plus, the minority extracting teeth first often find that their plan covers removable dentures but not the permanent crowns that snap onto the abutment.
Patients in this category pay the total retail price for a single tooth implant: $3,500
Network Providers
When dental insurance covers implants, in-network dentists cannot charge more than the allowed amount. Issuing companies negotiate a fixed fee schedule with providers, typically lower than the retail price. Out-of-network offices do not agree with these discounted rates and charge whatever they like.
The total allowed charges for a single tooth implant could be very different.
- In-network providers: $2,500
- Out-of-network providers: $3,500
Expense Sharing
Every dental plan has unique expense-sharing features, so you must look up the details for your coverage. For illustration purposes, we will use these example numbers.
- Annual deductible: $100
- Yearly benefit maximum: $1,500
- Copayment for restorative care: 50%
Your final out-of-pocket cost estimate for a single tooth implant is divided into two parts based on your provider’s network status.
| In-Network | Out-of-Network | |
|---|---|---|
| Charges | $3,500 | $3,500 |
| Allowed Amount | $2,500 | N/A |
| Deductible | $100 | $100 |
| Copayment | ($1,200) | ($1,500) |
| Patient Owes | $1,300 | $2,000 |
Full-Mouth Implant Costs
The most critical factors determining the cost of full-mouth dental implants with insurance differ due to the hefty retail prices. Likewise, you will need to utilize unique strategies to minimize your expenditures.
For illustration purposes, we compare the average retail price of $35,000 in the USA for the All-on-Four technique and whittle it down to $32,000, $22,000, and $8,500.
Annual Maximum
The annual maximum is the most critical factor in determining the cost of getting a full mouth of dental implants with insurance. This feature defines the limit your plan will pay each year.
Medical Maximum
Patients who can prove their dental implants are medically necessary to pay the least out-of-pocket for a full-mouth restoration because medical insurance does not limit benefits through an annual maximum.
The patient responsibility is much smaller because only two expense-sharing features apply when covered by a healthcare plan.
- Deductible: $1,500
- Coinsurance (20%): $7,000
- Total Owed: $8,500
Dental Maximum
Patients who cannot prove their tooth implants are medically necessary pay the most out-of-pocket for a full-mouth restoration because dental insurance typically limits benefits through an annual maximum.
Dental insurance with no annual maximums exists, but most patients have no plans for this feature. Our example plan noted above is more typical and stops paying claims above $1,500, a tiny fraction of the retail price.
Spreading treatment over two years leads to only a modest cost reduction.
- Upper & lower bridge in one year: $33,500 owed
- Upper & lower bridge in two years: $32,000 owed
Meanwhile, combining treatment into one year leads to a more significant cost reduction. IRS-sponsored discounts on tax-deductible dental implant expenses grow with consolidation.
Health Savings Account
The cost of full-mouth dental implants is lowest with a High-Deductible Health Insurance Plan (HDHP), even when the procedure is not medically necessary. You can use your Health Savings Account (HSA) to pay the dentist.
An HSA is a tax-favored account connected to an HDHP.
You can use your HSA to pay for full-mouth dental implants even though the average retail price ($35,000) exceeds the annual contribution limits ($7,300 for a family). If you establish an account before incurring a qualifying expense, you can repay yourself later using tax-favored dollars, provided you continue with an HDHP.
Consider this example for a hypothetical married couple (not retired) with a combined AGI of $100,000 who work in California.
| Charges | $35,000 |
| Federal Income Tax (22%) | ($7,000) |
| FICA Tax (7.65%) | ($2,670) |
| State Tax (9.35) | ($3,260) |
| Net Cost | $22,070 |
