Does Ambetter Cover Dental Implants? A Simple Guide to Your Coverage
Are you wondering if Ambetter pays for dental implants? You’re not alone! This easy article will explain dental implant insurance, what Ambetter pays for, how much you might have to pay out of your own pocket, and the steps you can take next. If you want a better smile or need new teeth, keep reading. You’ll learn smart ways to use your Ambetter benefits, get clear about costs, and see what else you can do if implants are too expensive.
Table of Contents
Quick Answer: Ambetter Dental Implant Coverage Overview
Let’s get right to it—most Ambetter plans do not completely pay for dental implants for adults. For adults, Ambetter’s dental coverage is usually only for things like cleanings, basic checkups, and small repairs like fillings. But there can be a few exceptions. If you bought a special or extra dental plan through Ambetter, or your implant is needed because of an injury, you might get help with some of the cost.
Don’t just guess. Ambetter coverage can change depending on your state, what type of plan you picked, and if you got dental coverage on purpose. To stop big bills, check your plan details and talk to Ambetter’s help team directly.
Understanding Ambetter’s Dental Coverage
Built-In vs. Extra Dental Plans
Ambetter has health insurance, and sometimes this comes with dental coverage. Here’s where it gets tricky: Dental coverage for adults is not always part of your original plan. You might need to buy a separate dental plan, an “extra” on top of your main health plan.
If you have children younger than 19, dental coverage usually comes with the plan because the law (Affordable Care Act) says so. But that doesn’t mean all adults are included!
Important Insurance Words to Know
- Deductible: Money you pay first before Ambetter starts helping.
- Coinsurance: After you pay your deductible, this is the percent you still have to pay.
- Copay: A flat fee you pay for each dentist visit.
- Annual Maximum: The most Ambetter will pay for you in one year, usually $1,000–$2,000.
- Waiting Period: How long you must wait (often 6–12 months) before you can get big things done, like implants.
All these things can mean you pay a lot yourselves, even if it sounds like your plan covers implants.
Does Ambetter Pay for Dental Implants?
Here’s the main problem: You need a new tooth, but dental implants cost a lot. You hope Ambetter can pay. It makes sense—implants help you eat, speak, and feel good.
But here’s where many people get upset. Most normal Ambetter plans, especially marketplace ones, do not include implants for adults. If you see dental coverage on your plan, read the details: it’s almost always just for cleanings or maybe small repairs.
Even if your plan has some coverage for implants, you’ll likely pay 50% (or more) after your deductible, and you could use up your yearly coverage before the implant is even finished.
So, what can you do?
Will Ambetter Cover Every Part of the Implant?
A dental implant isn’t only one thing. First you may need the old tooth taken out, then the metal post is put in, the middle part (abutment) goes on, and last comes the fake tooth (crown). Sometimes there’s other prep, like adding bone.
Here’s a simple table to show what’s often paid for:
| Implant Step | Often Covered? | Extra Info |
|---|---|---|
| Tooth Extraction | Sometimes | More likely if you need it for medical reasons |
| Bone Graft/Sinus Lift | Seldom, unless injury | Must be a real medical need |
| Implant Post | Almost never | Usually counted as “big repair” and not paid for |
| Abutment | Almost never | Sometimes if it’s for fixing damage from an accident |
| Crown for Implant | Maybe, but limited | Might be paid as any “crown”, but often not for implants |
Small tip: Sometimes, if the post isn’t covered, Ambetter could still help pay for the crown or getting the old tooth out. That’s better than nothing!
What Are the Limits and Rules for Ambetter Dental Benefits?
Let’s talk numbers, because this is where it really matters.
- Annual Maximums—Most dental plans, even good ones, stop at $1,000–$2,000 a year.
- Coinsurance for Big Jobs—Usually 30% to 50%. So, even with some help, you pay at least half after your deductible.
- Waiting Periods—Major dental work often means you wait 6-12 months after your plan starts.
- Network Rules—Dentists who are in your plan’s network usually cost less. Going to one not in the network might mean Ambetter pays nothing.
Example: If your implant is $4,000 and your yearly max is $1,500, you still pay at least $2,500 yourself—maybe more if there’s a deductible and coinsurance. That’s a big bill!
How Do I Check My Ambetter Plan for Dental Implant Benefits?
Before making an appointment for a dental implant, look over your Ambetter plan’s details. You’re the detective, and the clues are in:
- Summary of Benefits and Coverage (SBC)
- Evidence of Coverage (EOC)
- Your online member area at Ambetter
Check these things:
- Does it say implants are paid for, not paid for, or not mentioned at all?
- What’s the max amount Ambetter will pay, and what share do you pay?
- Are just some things, like crowns, paid for?
- Do you need to get approval before the work?
Quick Steps
Tip: Don’t guess. Dental insurance words can hide lots of “surprises.”
Do I Need Pre-Authorization for Implant Surgery?
Yes—you almost always need Ambetter to say “ok” before you get a dental implant. What’s this mean? Ambetter checks your case before you get treated to see if they’ll pay anything. If you skip this, they might say “no” to your claim!
What Will You Need?
- Your dentist’s or oral surgeon’s plan for treatment
- X-rays or mouth scans
- A note explaining why you need it (hurt, disease, or other medical reason)
- Sometimes, special codes for what treatment you get
Ask your dentist’s office for help with this—they see this a lot.
Important: Getting approved can take a while—sometimes a few weeks. Plan ahead!
What If Ambetter Doesn’t Cover Dental Implants?
If Ambetter says “no,” don’t worry, you still have choices:
Are There Cheaper Alternatives to Dental Implants?
If the price of implants is too high, don’t give up. Dentures and bridges are old-school fixes, and Ambetter is much more likely to pay for these.
- Dentures: Fake teeth you can take out. Cheaper than implants and usually at least partly paid for.
- Bridges: Uses crowns on nearby teeth to fill a gap. Cheaper than implants and more likely to get insurance help.
Quick Table
| Option | Pros | Cons |
|---|---|---|
| Implants | Very strong, last long, look real | Most expensive, not often paid for |
| Bridges | Lower price, easy, covered more | May need healthy teeth shaved |
| Dentures | Fast, cheap, usually covered | Can feel loose or click sometimes |
Want to learn more about these choices? Read our simple guide to dental problems.
How Do I Plan and Pay for Dental Implants?
After you learn what Ambetter pays and what’s left for you, make a plan:
If you want the best materials for your implants or crowns, some implant dental laboratories make strong and nice-looking new teeth. A good dental lab can make you smile with confidence.
Frequently Asked Questions
Q: Does Ambetter from [my state] pay for dental implants?
It changes a lot depending on your state and plan. Some places offer extra dental plans that pay part of the cost, but many don’t. Always check your own plan.
Q: Are bone grafts always paid for if needed for an implant?
No. Usually only if the bone graft is from an injury, not just to put in an implant. You must show why it’s needed.
Q: How much will I pay for a dental implant with Ambetter?
Most people pay $2,000–$5,000 per implant, even if some insurance helps, because of yearly limits and your share to pay.
Q: Does Ambetter pay for cosmetic dental work?
Almost never. Insurance is only for fixing bad teeth from hurt or sickness, not for “look better” reasons.
Q: How long does it take to get approval before surgery?
It often takes 2-4 weeks or more. Ask Ambetter and your dentist to check and plan ahead.
Summary: What Should You Remember?
- Ambetter almost never pays for dental implants for adults with basic plans—always check your specific policy and ask Ambetter yourself.
- Your share, yearly limits, and deductibles make the cost high.
- Extra dental plans can help, but might not cover everything.
- Getting approval before any implant is key.
- Dentures and bridges are good choices—they cost less and Ambetter is more likely to help pay.
- Stick with in-network dentists and double-check everything before you start so you don’t get big bills.
- Try payment plans, dental schools, and dental labs for good crowns and teeth if you want to save money.
Want to know more about dental implants themselves? Check out our step-by-step guide.
Take charge of your dental health! Don’t be shy to ask questions, look at every option, and speak up for the help you need. A healthy smile is worth it—just be sure you know what your plan really pays!
