Many of our patients use dental insurance for at least part of their care, and the two questions we hear most are whether we take their plan and whether their dental insurance will cover dental implants or gum treatment. This page answers both. Below you’ll find the dental insurance plans we accept at our Manhattan, Westchester and New Jersey offices, what dental insurance typically pays toward implants and periodontal treatment, and how to get the most from your benefits, including the ones that run out on December 31.
Dental Insurance Plans We Accept
We work with many PPO dental insurance plans. The lists below cover the plans our offices work with most often; if yours isn’t listed, call us and we’ll check it for you.
Manhattan And Bronxville (Westchester)
- Aetna
- Altus
- Ameritas
- Assurant
- Guardian
- Healthplex
- Humana
- Lincoln Financial
- Meritain Health
- MetLife
- Principal
- Solstice
- Sun Life
- United Concordia
- UnitedHealthcare
Nutley, New Jersey
- Advantica
- Aetna
- Ameritas
- Best Life and Health Insurance Co.
- Boon-Chapman Benefit Administrators
- Cigna
- Cypress Benefit Administrators
- Delta Health
- Dominion Dental Services
- Group Dental Services (GDS)
- Healthcare Solutions Group
- Humana
- INETICO
- Oxford
- UnitedHealthcare
Long Island (Franklin Square)
Our Long Island office in Franklin Square does not participate in dental insurance plans, and patients there are seen as private patients.
Plans We Don’t Participate In
We do not participate in HMO or DMO dental plans, or in Medicaid plans such as Fidelis, Emblem, MetroPlus, Health First and Affinity. If you have one of these plans, you are still welcome to see us as a private patient, and we’ll go through payment options with you.
Does Dental Insurance Cover Dental Implants?
Sometimes, and usually in part. Whether your dental insurance covers dental implants depends on the plan your employer or you chose, not on the procedure. Many dental insurance plans now include some coverage for implants, but very few cover the full cost of implants, and some traditional dental insurance plans still exclude them altogether. Older policies rarely cover implants at all, and a full-arch treatment will almost never be fully covered.
Where a plan does include coverage for dental implants, it is usually classed as a major service. Major services are typically paid at around 50% after your deductible, and everything counts toward your annual maximum, which on many plans is somewhere between $1,000 and $2,000 a year. In practice that means insurance may cover a meaningful share of a single implant but only a small part of the cost of multiple implants or a full-arch treatment.
Several clauses decide what you actually get back:
- Annual maximum. The most your plan will pay in a benefit year, across all your dental care, not just implants.
- Waiting periods. Many plans won’t pay for major services until you’ve been enrolled for six to twelve months.
- Missing tooth clause. Some policies won’t pay to replace a tooth that was lost before your coverage began.
- Alternate benefit clause. Some insurance companies classify implants as an upgrade and pay only what they would have paid for a bridge or denture. You can still choose the implant, and the plan pays its share toward it.
- Frequency limits. Plans often limit how often a crown or prosthesis on the same tooth can be replaced.
What Parts Of A Dental Implant Procedure Might Be Covered By Insurance?
A dental implant procedure is several treatments, and your insurance coverage can differ for each one. Depending on the plan, any of these may be covered:
- The consultation, exam and X-rays, and sometimes the 3D CBCT scan
- Extraction of the failing tooth
- Bone grafting or ridge preservation, if the site needs it
- Placement of the implant itself, the titanium or zirconia post in the jaw
- The abutment and the crown, bridge or denture on top, which some plans pay under prosthetic benefits rather than as surgery
Even when the implant isn’t covered, the extraction, the graft or the crown often is. That’s why it’s worth asking for a full breakdown rather than a single yes or no on whether dental implants are covered by insurance. For a sense of the overall cost of dental implants, see our page on how much dental implants cost.
Does Dental Insurance Cover Gum Disease Treatment And Gum Surgery?
Usually, yes. Periodontal treatment is treatment of an infection, not a cosmetic service, so most dental insurance plans cover it. Scaling and root planing is typically paid as a basic service. Periodontal surgery, including gum grafting and pocket reduction, is often paid as basic or major depending on the plan. Periodontal maintenance cleanings after treatment are usually covered too, sometimes with their own frequency limit.
Coverage for LANAP laser gum surgery depends on how your plan treats the procedure codes, and some plans reimburse it at the same rate as conventional surgery. Seeing a periodontist rather than a general dentist doesn’t usually change what your plan pays, although out-of-network benefits can differ. Our page on gum disease treatment explains the options themselves.
Maximize Your Insurance Benefits Before They Reset
Most dental insurance plans run on the calendar year, so your annual maximum resets on January 1st. Benefits you don’t use by December 31 are usually gone; very few plans let unused benefits roll over. If you have treatment planned, or you’ve been putting it off, the last few months of the year are when it pays to act:
- Use this year’s maximum. If you haven’t used your annual maximum, starting treatment before December 31 lets this year’s benefits pay toward it.
- Split treatment across two benefit years. Implant treatment happens in stages, with healing time between them. Where your treatment plan allows, one stage can fall in this year’s benefits and the next in January’s, so you draw on two annual maximums instead of one.
- Use your FSA. Flexible spending account funds are often use-it-or-lose-it too, with a deadline set by your employer. Dental treatment, including implants, is generally an eligible expense. HSA funds don’t expire, but they can be used the same way.
- Check your deductible. If you’ve already met this year’s deductible, treatment before the reset costs you less than the same treatment in January.
Can Medical Insurance Cover Dental Implants?
Occasionally. Medical insurance may cover dental implants or related surgery when tooth loss results from an accident, a tumor or another medical condition, and the treatment is documented as medically necessary. It doesn’t apply to routine tooth replacement. Original Medicare does not cover routine dental care, including implants, although some Medicare Advantage plans include dental benefits. If you think your situation qualifies, tell us at your consultation and we’ll provide the documentation your insurer needs.
How We Help You Navigate Insurance
You shouldn’t have to decode your own insurance policy or spend an afternoon on hold to contact your insurance provider. If we work with your insurance plan, our team will:
- Check your eligibility and remaining benefits before treatment
- Submit a pre-treatment estimate to your insurance provider, so you know what your plan expects to pay before you commit
- Explain your out-of-pocket cost for each stage, separately
- File your claims for you
Payment And Financing Options
Whether you’re covered by insurance or not, we’ll work with you on a payment plan that fits your budget. We offer financing through CareCredit, Happen Bank, Alphaeon, Cherry and Sunbit, which can spread the part your insurance doesn’t cover into monthly payments. These options can make implants more affordable when your dental insurance plan pays only part of the cost or none of it.
Dental discount plans are another route some patients ask about. They aren’t insurance: you pay a membership fee in exchange for reduced fees at participating practices. Check whether a discount plan is accepted before you buy one with implants in mind.
Check Your Coverage At A Consultation
If you’re considering dental implants or gum treatment, bring your insurance details to your consultation, or call ahead and we’ll verify your benefits before you arrive. We’ll tell you what your plan is likely to pay, what it won’t, and how to time treatment so you get the most from your coverage.
Call us at (347) 493-2439 or schedule your consultation online.
Frequently Asked Questions
Do You Accept My Dental Insurance?
Our Manhattan, Westchester and Nutley offices work with many PPO dental plans, including the plans listed above. Our Long Island office doesn’t take insurance. If your plan isn’t listed, call us before your visit and we’ll check it.
How Much Does Dental Insurance Usually Pay For Implants?
Where implants are covered, plans commonly pay around 50% of the covered cost after the deductible, up to the annual maximum. Because annual maximums are often $1,000 to $2,000, the maximum usually limits the payment more than the percentage does.
Why Doesn’t My Insurance Cover Dental Implants?
When insurance doesn’t cover implants, it’s usually because the plan still treats them as optional or cosmetic, or pays only the cost of a bridge or denture instead. Your policy’s exclusions, waiting periods and missing tooth clause decide the answer, which is why we request a pre-treatment estimate.
Is Dental Insurance Worth It If I Need Implants?
It can be, especially for the parts around the implant, such as extractions, grafting and the crown. If you’re buying a new plan specifically for implants, check the waiting period for major services and the annual maximum before you enroll.
Do I Need A Referral To See A Periodontist?
Most PPO plans don’t require one, although some plans do. We’ll confirm when we check your benefits.
Can I Use My FSA Or HSA For Dental Implants?
Yes. Dental implants are generally an eligible expense for both, and FSA funds often need to be used by the end of your plan year.
What If My Insurance Denies Coverage For Dental Implants?
We can help you appeal where there are grounds, for example when the clinical records show the implant is necessary. If coverage still isn’t available, financing can spread the cost.