Patients with missing or decayed teeth should estimate the costs of dental implants that insurance does not cover.
Those with existing coverage might find their plan pays 0% to 50% of the allowed amount. Those looking for a new plan should consider the monthly premiums.
An accurate estimate depends on many factors, like the number of teeth replaced and the dental insurance benefits that vary by plan.
See how an example policy affects the costs not covered by insurance for a single-tooth implant, an implant-supported bridge, and a full-mouth replacement.
Dental Insurance Benefits
The cost of tooth implants with dental insurance depends on the benefits of each plan, and these benefits can vary a lot. Explore how expense-sharing, policy exclusions, and plan types might affect out-of-pocket costs.
Expense Sharing
Most dental plans include expense-sharing features that affect the costs patients must pay for tooth implants. The policy documents should explain the yearly limit and coinsurance.
Annual Maximum
The annual benefit maximum is most important for patients replacing multiple teeth. This feature limits what the plan will pay in one year.
The average annual maximum is about $1,500, about half the price of a single tooth implant, and far less for full-mouth replacements.
Treatment spread over three plan years is possible because patients need time to heal between steps. You can triple what your plan pays by scheduling services this way.
| Treatment Step | Healing Time | Plan Year |
| Tooth Extraction | 3 Months | 1 |
| Bone Grafting | 6 Months | 2 |
| Body Placement | 6 Months | 2 |
| Abutment Insertion | 3 Months | 3 |
| Crown Installation | 0 Months | 3 |
| Total Time | 18 Months |
Coinsurance
Coinsurance affects all patients equally, no matter how many teeth they replace. It is the portion of the patient’s cost after meeting the deductible.
Typical coinsurance for restorative services ranges from 40% to 70%, so plan your budget accordingly.
Policy Exclusions
Many dental insurance plans have exclusions that could affect your out-of-pocket costs. Read the policy documents carefully to make sure they do not exclude implants. Then, check for waiting periods and missing tooth clauses in the policy.
Waiting Period
Many dental plans that cover implants have waiting periods. This exclusion means you must wait 12 to 24 months before receiving benefits after buying the insurance.
You must pay the monthly premiums during the waiting period without receiving benefits. Plan for these 12 or 24 months in your budget.
Missing Tooth Exclusion
Many dental plans have missing tooth exclusions, meaning the insurance will not cover prosthetic devices for teeth lost before the policy starts.
Expect to pay the full cost unless you find a plan without a missing tooth exclusion. Employer-based group coverage is often the best option, as shown in our example below.
Implant Exclusions
Many dental insurance plans do not cover tooth implants. If your plan excludes them, expect to pay the full price.
Dentures are a less expensive tooth replacement option. More dental plans cover dentures, deeming them necessary. Many insurers classify implants as cosmetic.
Design Types
The type of dental insurance affects the unreimbursed cost of implants. Each design impacts overall spending differently.
- Preferred Provider Organizations (PPO) plans have a network of dentists who agree to provide services at reduced rates.
- Dental Health Maintenance Organizations (DHMO) provide services at no charge or a reduced cost. You must stay within the network for coverage.
- Indemnity Plans (Fee-for-Service) allow you to visit any provider, and the insurance company pays a percentage of the dentist’s retail fee.
- Direct Reimbursement Plans pay a percentage of patients’ spending on dental care regardless of the services rendered.
Dental Insurance Examples
An example dental insurance policy shows how plan features affect out-of-pocket costs for single-tooth implants, bridges, and full-mouth replacements.
The BCBS FEP dental insurance covers implants and will be our example coverage. Federal employees (including postal workers and active duty military members), retirees (including veterans), and their family members can participate.
Eligible family members can choose from two options.
- High Plan: PPO with higher premiums and richer benefits
- Deductible: $0
- Coinsurance: 50%
- Annual Max: Unlimited
- Standard Plan: PPO with lower premiums and limited benefits
- Deductible: $0
- Coinsurance: 65%
- Annual Max: $1,500
Single Tooth
Suppose the retail price of a single tooth implant is $3,500—the estimated out-of-pocket costs with the example dental insurance range from $1,225 to $1,593.
Patients buying the standard coverage would save $2,275 on a plan with $14 monthly premiums for an individual.
| High | Standard | |
|---|---|---|
| PPO Allowed Amount | $2,450 | $2,450 |
| Coinsurance | $1,225 | $1,593 |
| Annual Max Remainder | $0 | $0 |
| Total Cost | $1,225 | $1,593 |
Supported Bridge
Suppose the retail price of an implant-supported bridge is $10,000 – the unreimbursed costs with the example dental insurance range from $3,500 to $5,500.
Patients save an additional $2,000 on an implant-supported bridge with the high plan compared to the standard option. The high plan does not limit the annual benefit for this expensive service.
The high plan monthly premiums are only $11 more for an individual, making it a better choice than the standard option for patients needing to replace multiple teeth.
| High | Standard | |
|---|---|---|
| PPO Allowed Amount | $7,000 | $7,000 |
| Coinsurance | $3,500 | $2,167 |
| Annual Max Remainder | N/A | $3,333 |
| Total Cost | $3,500 | $5,500 |
Full Mouth
Suppose the retail price for full-mouth implants is $40,000 – the left-over costs with the BCBS FEP dental insurance range from $14,000 to $26,500.
Patients save an additional $12,500 on a full-mouth implant replacement with the high plan compared to the standard option, illustrating the value of insurance with unlimited annual benefits.
The high plan monthly premiums are only $11 more. Still, the extra value is phenomenal for patients with extensive needs, such as full-mouth replacement.
| High | Standard | |
|---|---|---|
| PPO Allowed Amount | $28,000 | $28,000 |
| Coinsurance | $14,000 | $2,167 |
| Annual Max Remainder | $0 | $24,333 |
| Total Cost | $14,000 | $26,500 |
