Does Dental Care Plus Cover Dental Implants? My Straightforward Guide to Coverage, Costs, and Choices

Table of Contents

• Are Dental Implants Major Restorative Procedures?
• What Are the Typical Insurance Coverage Percentages for Implants?
• Annual Maximums: The Silent Cost Cap

• Waiting Periods: The Waiting Game
• Pre-Authorization: Why You Need Insurer’s Blessing
• Medically Necessary or Cosmetic?
• Employer Plans vs. Individual Plans: What’s the Difference?

• Diagnostics: X-Rays, Exams, and More
• Tooth Extraction
• Bone Grafts and Sinus Lifts: The Grey Area
• The Implant Surgery Itself
• Abutments and Crowns
• Anesthesia Isn’t Always a Given

• Decoding the Policy Document
• Getting the Most from the Member Portal
• Calling Customer Service: The Conversation That Matters
• Teamwork: Working with My Dentist’s Office

• Creative Financing and Payment Plans
• Dental Discount Plans: Worth a Look?
• Dental Schools and Community Clinics
• HSAs, FSAs, and Other Savvy Savings
• Forging Ahead or Rethinking? Weighing Implants vs. Other Options

Introduction: My First Steps with Dental Care Plus and Dental Implants

When I started looking up dental implants, my main question was pretty clear: Does Dental Care Plus pay for dental implants? It’s not just about teeth—it’s about money, confusing rules, and trying to make sense of all that insurance talk.

Turns out, the answer isn’t just yes or no. It all depends on your own Dental Care Plus plan. What I found out was that finding out about implant coverage is more like trying to finish a puzzle, and a lot of the pieces are pretty well hidden.

In this article, I’ll tell you what I learned. I’ll show you how coverage often works, where things get tricky, what kind of bills to expect, and—maybe most important—how to put yourself in the best spot to save money and keep your smile healthy.

The ABCs of Dental Implants and Insurance

Are Dental Implants Major Restorative Procedures?

When I checked my Dental Care Plus plan, I saw a list called “major restorative services.” This usually means crowns, bridges, dentures, and sometimes dental implants. Dental Care Plus, like most insurance companies, often thinks of implants as major dental work.

Why does this matter? Because major restorative work gets different coverage than cleanings or fillings. For me, if implants were included, they fell in this group, and that meant the plan paid less toward them than for regular cleanings or small fixes.

Quick tip:

If your plan says “implants not covered,” you have your answer. But if it’s not clear or just says “major services covered,” don’t guess—ask directly! Sometimes you need to talk to your insurance or your dentist to make sure.

What Are the Typical Insurance Coverage Percentages for Implants?

Dental insurance almost never pays the whole bill for implants. My Dental Care Plus plan (and others like it) paid around 20% to 50% of the cost—if they paid for implants at all. This was after meeting the yearly deductible. The rest of the bill was mine.

Also, there’s coinsurance—that’s the part I still owed after insurance paid their share. So, if my plan paid 50% of a $4000 implant bill, and I hit my deductible already, insurance paid $2000 and I paid $2000. Easy math, but not so easy on my wallet.

Real World Example:

A friend needed a single implant. Her Dental Care Plus plan paid 40% after she met her deductible. The work cost $4000, the yearly deductible was $100, and her yearly maximum was $1500. In the end, she paid $2500 herself.

Annual Maximums: The Silent Cost Cap

One of the most hidden problems in dental insurance is the annual maximum. Most plans, including mine, only pay out $1000 to $2000 a year. That sounds okay, but a single implant (the post, abutment, and crown) often costs double that, even if you have insurance.

What I didn’t know at first: when you hit your yearly maximum on covered dental work, anything else for the rest of that year is on you. Some smart folks space out their implant steps over two years—like getting the post one year, the crown the next—to make the most of their insurance. It’s not always possible, but sometimes it helps save money.

The Fine Print: Factors Shaping Your Dental Care Plus Implant Coverage

Waiting Periods: The Waiting Game

Most dental insurance, including Dental Care Plus, has waiting periods. For implants and other big work, that can mean waiting 6 to 12 months from when you sign up before they’ll pay for any of it.

When I joined my plan, I had to ask: “Do I have to wait to use my benefits for implants?” The answer was yes. If you’re new to your plan, check your waiting period before you schedule anything big. There’s nothing worse than finding out you have to wait months before insurance kicks in.

Pre-Authorization: Why You Need Insurer’s Blessing

Dental Care Plus wanted to know what work I planned to get before they’d agree to pay for it. This step is called pre-authorization. My dentist sent in x-rays, the treatment plan, and special codes (like D6010 for the implant) to the insurance for approval.

Without this, I could end up with a big surprise bill if insurance decided not to pay after the fact. I always think it’s best to let your dental office send these in—they’re used to dealing with insurance.

Medically Necessary or Cosmetic?

One of the first things I learned: insurance cares if the work is for health or just looks. If I lost a tooth because of an accident, infection, or cavity, an implant was more likely counted as “restorative” and maybe covered.

But if I wanted an implant just to make my smile a little nicer—especially if it was a tooth you can’t even see—I’d probably hear “no” from Dental Care Plus. My paperwork had a spot for medical need. If my dentist could explain why the implant really mattered (not just for looks), it helped.

Employer Plans vs. Individual Plans: What’s the Difference?

This part surprised me. Dental Care Plus plans you get from work sometimes have better benefits or higher yearly payouts than individual plans you buy yourself. When I changed jobs, I found my new work plan didn’t have a waiting period for big dental work—a small win!

If you’re picking a plan, check all those details. Sometimes, work plans really are better, especially when it comes to expensive stuff like implants.

A Closer Look: Which Parts of a Dental Implant Could Be Covered?

Getting an implant isn’t just one thing. It’s a bunch of steps, and each step has its own cost and chance of getting covered. Here’s how Dental Care Plus handled each part with me.

Diagnostics: X-Rays, Exams, and More

Before even talking about implants, I needed x-rays, exams, and maybe a 3D scan. Thankfully, insurance like Dental Care Plus often pays for these as “preventive” or “diagnostic” work. That meant little or no cost for me at this stage.

Tooth Extraction

If a bad tooth had to come out first, this was called a “basic service” in my plan. Dental Care Plus paid anywhere from 70% to 80% after the deductible. That helped a lot.

Bone Grafts and Sinus Lifts: The Grey Area

This part got confusing. Extra things like bone grafts or sinus lifts for implants were hardly ever a sure thing. Most times, Dental Care Plus said they were “elective” or not needed. Sometimes, if my dentist could prove it was medically needed because of bone loss, there was a small chance they’d help pay. Good notes from my dentist made a difference.

Also, these steps can get pricey. Always ask your dentist to send in a pre-treatment estimate before you decide.

The Implant Surgery Itself

When I thought of an implant, I really just pictured the metal screw—the part that goes in the bone. This is the main surgery, and if my plan covered major dental work, this is what they covered a bit of.

Remember, coverage is usually just 20–50% of the “usual” charge, up to that yearly maximum. Sometimes, insurance only paid a set dollar amount, and I paid the rest.

Abutments and Crowns

The implant abutment and crown (the fake tooth) were billed separate from the post. If major dental work was covered, my Dental Care Plus plan paid a similar percent for these, still up to the yearly limit.

One thing: the type of crown—like porcelain or zirconia—changed the price. A good dental ceramics lab can make your tooth look natural, but insurance almost never covers the extra cost for high-end materials.

Anesthesia Isn’t Always a Given

Regular numbing (local anesthesia) was just part of the usual cost. But if I wanted to be put to sleep, or needed sedation (some do, for tough cases or if they get really nervous), insurance didn’t always pay unless it was really needed. Your dental team should help send in all the right papers if you want to try for coverage.

How I Confirmed My Dental Care Plus Implant Coverage

This was the detective work part! Here are the steps I took to get clear answers.

Decoding the Policy Document

My Dental Care Plus policy guide—called the Summary Plan Description—was my main guide. I looked for “major restorative services,” “exclusions,” and any mention of implants, or codes like D6010 (implant), D6056 (abutment), or D6058 (crown).

If the plan said “no implant coverage,” that was it. But plans can change yearly, so I didn’t just trust last year’s info.

Getting the Most from the Member Portal

Most dental plans, including Dental Care Plus, have a website where you can check your benefits, how much you’ve used, and what’s left this year. I checked for major services, yearly max, my deductible, and waiting periods.

If you haven’t tried the member portal, do it! It’s usually the most up-to-date info you can get.

Calling Customer Service: The Conversation That Matters

Sometimes, the website wasn’t enough. I called Dental Care Plus and asked straight questions:

• “Is code D6010 covered on my plan?”
• “What’s my yearly maximum for big dental work?”
• “Do I have a waiting period right now?”
• “Does coverage pay for both the implant and the crown?”

I took notes and followed up by email so I would have proof later, just in case.

Teamwork: Working with My Dentist’s Office

The people at my dentist’s office were a big help. They were good at dealing with Dental Care Plus and sent in my pre-treatment estimates. They knew the right codes, what papers were needed, and how to make things clear to get a “yes” from insurance.

If insurance words confuse you, let your dentist’s office help explain. They can often clear things up quicker than you could by reading for hours.

Bucking the System: Alternatives If Coverage Falls Short

Dental Care Plus, like many plans, doesn’t always pay as much as you’d hope—sometimes they pay nothing. Here’s what I looked into.

Creative Financing and Payment Plans

A lot of dental offices have payment plans or work with companies like CareCredit. This let me break up my bill into smaller payments, sometimes with no interest for a few months.

Check the details though—interest can get high after the no-interest time runs out!

Dental Discount Plans: Worth a Look?

Dental discount plans aren’t insurance, but they take 10–60% off at certain dentists. They come in handy if Dental Care Plus doesn’t cover implants at all. Be sure to check if your dentist works with any discount plan you find.

Dental Schools and Community Clinics

If money is tight and you’re not in a rush, try a dental school. Students, watched by teachers, do implant work for less. It may take longer, but the savings are real. Some community clinics also help with costs if you qualify.

HSAs, FSAs, and Other Savvy Savings

If you get a Health Savings Account (HSA) or Flexible Spending Account (FSA) at work, you can use those dollars for implants. I used my HSA, which made the big bill hurt less thanks to tax savings. Just remember, FSA money often disappears if you don’t use it by the end of the year, while HSA money carries over.

Forging Ahead or Rethinking? Weighing Implants vs. Other Options

Dental implants aren’t the only way to replace a tooth. Bridges or removable dentures can be cheaper and sometimes covered better. But for me, my new tooth lasting a long time was worth it. No matter what you choose, talk to your dentist about the costs and your options—maybe ask about a crown and bridge lab or a removable denture lab if you’re not sure yet.

Final Thoughts: Moving Forward with Dental Implants

If you’re like me, you just want answers and a plan. Here’s what I learned:

• Coverage depends on your exact plan. Don’t guess—read, ask, and make sure.
• Implants are often only partly paid—if at all. You’ll probably pay some yourself.
• Yearly limits, deductibles, waiting times, and pre-approval matter a lot.
• There are ways to make implants cost less. Payment plans, discounts, and those savings accounts can help a lot.
• Your dental team and a little hard work go a long way toward getting all the coverage you can.

I wish dental insurance paid more for implants, but knowing where I stood helped me budget and avoid bad surprises. Whether you get your smile back with Dental Care Plus’s help or by being creative, the main thing is moving forward with confidence—and all the facts.

Frequently Asked Questions

Q: Does Dental Care Plus cover all types of dental implants?

A: If your plan covers implants, it’s usually only the regular kind, not mini implants or special types. Always ask to be sure.

Q: What’s usually NOT covered by insurance for implants?

A: Bone grafts, sinus lifts, and anesthesia are often not covered. Cosmetic upgrades or fancier crown materials (like full zirconia from a zirconia lab) are also rarely paid for.

Q: Can I use my Dental Care Plus coverage at any dental office?

A: Make sure your dentist is “in-network.” If not, you might pay more, or insurance might not pay at all, depending on your plan.

Q: How do I start the process?

A: Look at your plan, use the member website, call Dental Care Plus with direct questions, and talk to your dentist’s office about sending in a treatment estimate. Don’t skip these steps!

Q: What’s the most important thing to remember?

A: Insurance can be confusing, but it’s worth asking questions until you’re sure about every detail and every dollar—your smile (and wallet) will be glad you did.

I hope what I learned makes getting dental implants a little easier for you. If you’re still thinking about it, be sure to check every benefit and look at all your options. Your smile is worth the effort!