Dental implants can be covered by Medicaid when medically necessary. Pre-approval requests for implants must be supported by documentation from the patient's doctor and dentist. A letter from the patient's doctor should explain how the implants will help to alleviate the patient's medical condition. In some cases, health insurance can provide coverage for dental implant surgery if it is deemed medically necessary.
Qualifying services are “appropriate for the evaluation and treatment of an illness, condition, illness or injury and are consistent with the applicable standard of care.” If the loss of teeth has caused medical complications, or if the patient has had oral cancer, health insurance may cover some aspects of dental implant surgery. If both health and dental insurance plans offer coverage for dental implants, the benefits of each can be combined to reduce out-of-pocket costs. Generally, Medicaid does not cover dental implants as it is a government program that provides financial support to low-income families who would otherwise be unable to afford medical and dental care. However, if a patient has tried to preserve a sick tooth with proper oral hygiene and it didn't work, dental implants can be considered medically necessary.
In some cases, reconstructive dental services such as tooth extraction, orthodontic or periodontal services for fractured teeth, crown or bridge reconstruction, impacted wisdom teeth, and oral surgery to repair an injury may be billed to health insurance and applied to dental implant surgery. When a patient seeks dental implants to improve the function of their teeth or correct a functional deterioration of their teeth, then the procedure is considered medically necessary. Many insurance companies consider dental implants to be purely cosmetic and do not cover them. However, replacing missing teeth is essential for overall health and well-being.