Will Dental Insurance Cover Implants?

Dental implants have become a popular and effective solution for replacing missing teeth. However, the cost of dental implants can be a concern for many, prompting them to wonder if dental insurance will cover the expenses. 

The Ontario Health Insurance Plan (OHIP) does not cover dental services provided in a dental office. However, dental insurance policies can vary significantly.

What Is a Dental Implant?

Dental implants are artificial titanium tooth roots surgically inserted into the jawbone. They serve as a sturdy foundation for replacement teeth, such as crowns or dentures, offering a long-term solution to tooth loss. 

Dental implants resemble your natural teeth to restore function and aesthetics in the mouth. Your dentist may recommend dental implants in the following instances:

• To prevent bone loss if you have lost a tooth
• As an alternative to dentures
• To fill a gap when a tooth is missing to keep adjacent teeth stable
• To help maintain the structural integrity of the jaw
• To preserve speech patterns and chewing ability

Generally, the dental implant process involves multiple stages. Your implant process might look something like this: 

• Your dentist will first examine your mouth and take X-rays to see the health and condition of your jaw and teeth to determine eligibility.  
• Next, they will place the titanium post into your jawbone beneath the gum tissue. After this procedure, you will wait several months, giving the implant time to bond to the surrounding bone and tissue. 
• Once the tissue heals, the second stage involves placing an abutment or small post that helps attach the tooth replacement to the artificial root. Sometimes, your dentist may do the first and second stages in one appointment. 
• Then, your dentist attaches the tooth replacement, such as a crown, to the abutment. If more than one tooth is missing, your dentist may use a dental bridge. 

Coverage for Dental Implants 

The Ontario Health Insurance Plan does not cover those dental services provided in a dental office. However, they cover some in-hospital dental surgeries, such as:

• Fracture repair
• Tumour removal
• Reconstructive surgeries
• Medically necessary tooth removal 

Most traditional dental insurance plans focus on preventive care, such as regular exams and cleanings, and basic dental procedures, such as fillings and extractions. Dental insurance coverage for dental implants can be limited, with many plans considering this procedure cosmetic or elective. 

However, some insurance providers, which you might acquire through employee plans or private insurance, can offer dental implant coverage, though the extent of coverage can vary. Dental insurance plans that cater to dental implants and other major dental procedures help reduce the financial burden for individuals seeking this advanced tooth replacement option. 

Dental insurance plans often have annual maximums, which limit the amount the insurer will pay for covered treatments within a year. If the dental implant cost exceeds this maximum, you will most likely be responsible for the remaining expenses. 

What Does Your Plan Cover?

Coverage levels can depend on the following:

• Limits: Dental insurance plans often have annual maximums, which limit the amount the insurer will pay for covered treatments within a year. If the dental implant cost exceeds this maximum, you will most likely be responsible for the remaining expenses. 
• Percentage of coverage: Coverage plans rarely cover 100% of Major dental services. Major services include Crowns, Bridges, Implants & Dentures. Common percentages for Major coverage are often between 50-80%. Some plans do not cover Major services at all.
• Dual coverage: You may have additional coverage through a spouse or partner’s plan. 

Reading your coverage includes familiarity with the information booklet and other pertinent details from your provider. This may involve understanding key terms, such as:

• Deductible
• Maximum
• Limitations
• Exclusions
• Preauthorization

Factors Influencing Dental Coverage

Several factors can affect the extent of your dental insurance coverage for dental implants, including the following:

• Plan Type: Different types of dental insurance offer varying levels of coverage, so it is essential to review the details of your specific plan before undergoing a dental procedure. 
• Reason for Tooth Loss: Insurance providers may consider the cause of tooth loss when determining coverage. For instance, dental implants for teeth lost due to accidents or trauma may have better coverage prospects than teeth lost due to pre-existing conditions. 
• Policy Exclusion: Some dental insurance plans may have specific exclusions for certain procedures, including dental implants. Always review your policy’s fine print to understand any limitations or exclusions.
• Bone Grafting and Related Procedures: If bone grafting or other preparatory procedures are necessary before dental implant placement, the insurance coverage for these procedures may also impact overall implant coverage.

Despite having insurance, not everyone can get a dental implant. You are typically eligible for a dental implant if:

• You are in good general health
• You have healthy gums
• You have enough bone in the jaw to hold an implant
• You can have a bone graft if you do not have enough jawbone 

Improving Dental Health with Implants

The extent of dental insurance coverage for dental implants can vary significantly based on the type of insurance plan you have and the specific terms and conditions of the policy. While some insurance plans may offer coverage for dental implants, others might consider them elective procedures, leaving you with a higher out-of-pocket cost. 

Dental implants can significantly improve oral health and quality of life, so exploring your insurance options and speaking to your dentist about costs can help you make informed decisions regarding this transformative dental treatment.

Book an appointment with South Ancaster Family Dental to learn more about the various insurance plans we accept. Or contact our team to discuss treatment plans and understand the potential costs and coverage limitations.