Does Fidelis Care Cover Dental Implants? Your Complete Guide to Coverage, Costs, and Options

If you’ve lost a tooth or several teeth, you may be asking, “Does Fidelis Care cover dental implants?” This article gives you everything you need to know. We’ll walk through Fidelis Care dental coverage for implants, how much dental implants cost, what steps you should take, and the best options for your dental health—even if you need financial help. By the end, you’ll know exactly how to approach this big dental decision with confidence.

Table of Contents

What Is Fidelis Care and How Does It Work?

Before we talk about dental implants, let’s get to know Fidelis Care. Fidelis Care is a large health insurance company in New York. They have different kinds of plans, like:

• Medicaid
• Essential Plan
• Medicare Advantage
• Child Health Plus
• Employer and private plans

Every plan type has its own rules and pays for different dental things. If you want to find a dentist that takes your plan or get more info, Fidelis Care’s website has all their programs and contact details.

What really matters is that not every Fidelis plan pays for dental implants the same way. So it’s important to know which plan you have.

What Are Dental Implants and Why Choose Them?

Picture losing a tooth. You might think about dentures or bridges. But dental implants are a modern fix and have many benefits.

What Is a Dental Implant?

A dental implant is a tiny post (usually made from titanium or something similar) that a dentist or oral surgeon puts in your jaw. Once it heals, a connector is put on top and a fake tooth (crown) is put on. This works and feels like a real tooth.

Why Choose Dental Implants?

• They don’t slide or fall out like dentures
• Don’t damage nearby teeth (unlike bridges)
• They last a long time—sometimes forever
• You can eat and talk like normal

Implants can even help people who have dentures. For example, “All-on-4” implants let you put in a whole set of teeth that feel strong and look great.

Does Fidelis Care Cover Dental Implants?

Short Answer: It Depends

So, does Fidelis Care pay for dental implants? The answer isn’t always easy. Here’s the truth:

• Fidelis Care does not automatically pay for dental implants for everyone. It depends on your plan and if your dentist can show you really need them.

Some Fidelis plans may pay for some parts of the process. Others may not pay at all unless implants are “medically needed.” That’s the main thing: “Medically needed” is a key term we’ll explain soon.

Why Doesn’t Every Plan Pay for Implants?

Dental implants cost a lot more than other ways to replace teeth. Many times, they’re seen as “cosmetic”—meaning mostly for how you look and not always needed to eat or talk. Most insurance companies, not just Fidelis, feel this way.

But sometimes, dental implants aren’t just for looks! Sometimes, you really need them to eat, speak, or wear dentures. That’s where “medical need” matters.

How Does Dental Implant Coverage Differ by Fidelis Plan?

Every Fidelis plan is different. Here’s what you can expect.

Fidelis Care Medicaid

Medicaid pays for important dental work if it is medically needed. Dental implants with Medicaid are usually only paid for if there are big problems. For example, if you have big bone loss and normal dentures won’t work, you may get covered.

You’ll need:

• A letter from your dentist or oral surgeon
• Proof with X-rays or scans
• Pre-authorization before the surgery

Without these, Medicaid will usually say “no.”

Fidelis Essential Plan

This plan gives low-cost care for adults who don’t qualify for Medicaid. It’s a lot like Medicaid, with tough rules for dental implants. You usually only get covered if there is proof you can’t eat or work with other tooth options. You’ll need lots of facts from your dentist.

Fidelis Medicare Advantage

If you have Medicare Advantage from Fidelis, things are more tricky. Some Medicare Advantage plans have extra dental benefits, sometimes even for implants.

But here’s the catch:

• Not every Medicare Advantage plan has this
• Sometimes, only some parts of the implant process are paid for (maybe just the crown, not the post)
• There will be yearly dollar limits

Always check your “Evidence of Coverage” booklet to see the exact rules.

Fidelis Child Health Plus and Other Plans

For kids, dental implants almost never get paid for unless there’s a birth problem or an accident. The idea is, kids are still growing and implants are best done for adults.

What Makes Dental Implants “Medically Necessary”?

Here’s the big unlock—“medical need.”

Problem: What Does “Medically Necessary” Mean?

Insurance companies—including Fidelis—don’t pay for things just because you want them. The treatment has to be needed for your health.

Dental implants are usually only called “medically needed” if:

• You can’t chew or eat with dentures
• You can’t talk clearly without teeth
• An accident or illness has wrecked your teeth or jaw
• You have big jawbone problems that make dentures impossible

Agitate: What Happens If It’s “Just Cosmetic”?

If you want an implant only to look better—or replace just one missing back tooth—Fidelis will likely say no. They won’t pay for it.

Solution: How Do You Show Medical Need?

Talk with your dentist! Ask them to give records, X-rays, and letters. Your dentist should explain how implants will help you live better, not just look better. That’s your best shot at approval.

What Is Pre-Authorization and Why Is It Important?

You can’t just walk in to your dental surgeon and say, “Put in an implant.” Fidelis Care uses something called pre-authorization (or prior OK). Without this, you might get stuck with a big bill and no help from your insurance.

What Is Pre-Authorization?

Pre-authorization means Fidelis Care must say “yes” before you get the dental work. Your dentist or oral surgeon will need to:

Why Should You Care?

If you skip this step, Fidelis Care can deny you later—even after you already got the work! That leaves you paying.

So, don’t start pricey dental work until you know what Fidelis says. If they say yes, you’ll get it in writing. If they say no, they must tell you why.

How Much Do Dental Implants Cost With Fidelis Care?

Let’s talk money. Even if Fidelis pays some of the cost, dental implants cost a lot.

Typical Dental Implant Prices

Out-of-Pocket Costs

Even if Fidelis helps, there are limits called deductibles, co-pays, and yearly maximums. These mean you might only get help with a small part of a big bill.

Example:

• Fidelis might pay for the extraction but not all the implant.
• They might pay just for the post, but not for the fake tooth (crown).
• Yearly max may be $1,500 then you pay the rest.

That’s why a lot of people ask about payment plans or help from a dental clinic. The total cost depends on your plan and your needs.

How Can You Check Your Dental Implant Coverage?

You’re not alone if you’re confused. Here’s how you get answers:

Contact Fidelis Member Services

Call the phone number on your insurance card. Ask, “Does my plan pay for dental implants?” They can tell you if your plan pays for:

• Implants (post, connector, crown)
• Extractions and bone grafts
• Dentures or partials instead

Review Your Evidence of Coverage

Look in your booklet or online account for the Summary of Dental Benefits or Evidence of Coverage (EOC). If you see tricky words, ask your dentist or call customer service.

Talk to an In-Network Dental Provider

An in-network dentist or implant dental laboratory knows how Fidelis works. They can show you what paperwork to do and help with getting pre-authorization.

What Are Your Alternatives and Financial Options?

Sometimes, Fidelis won’t pay for implants—or you’ll still owe a lot. What should you do?

Try Other Dental Solutions

If implants are too expensive, ask about:

• Dental bridges: These fill spaces with fake teeth by attaching them to the nearby teeth. Sometimes, bridges are paid for by Fidelis or crown and bridge labs can help you save money.
• Partial dentures: Removable pieces that replace several missing teeth. Fidelis often pays for these.
• Removable denture labs can offer cheaper options if you need all your teeth replaced.

Ask About Financial Help

• Payment plans: Some dental offices let you pay for implants a bit at a time.
• Dental financing companies: Like CareCredit or local dental programs.
• Dental schools: If you live near a dental school, students (guided by teachers) can do your implants for much less.
• Dental discount programs: Special saving clubs—not insurance but can offer a discount for some treatments.

Appeal a Denial

If Fidelis says “no,” you can file an appeal. Your dentist or oral surgeon can help you write a letter and send new proof of why you need implants.

Tips for Making the Best Decision for Your Dental Health

Taking care of your teeth is about more than smiling. Here are simple tips I follow and suggest to others:

• Ask questions: Talk to Fidelis Care or your dentist. If you don’t get something, keep asking until you do.
• Check your plan: Don’t guess what’s paid for—read your plan or call for help.
• Work with experts: Dentists and digital dental labs know the steps and can help with the paperwork.
• Think ahead: Implants may cost more now, but last much longer than other choices.
• Don’t skip aftercare: Good care helps your implants last for years. Brush, floss, and see your dentist often.

Frequently Asked Questions

Q: Will Fidelis Care pay for all the cost of my dental implants?

A: Almost never. Coverage is usually limited. Fidelis may pay for some, but you’ll probably have to pay part yourself.

Q: Do I need approval ahead of time for dental implants with Fidelis?

A: Yes. Almost all Fidelis plans want a “yes” before you start treatment.

Q: If I am denied, can I appeal?

A: Yes. Work with your dentist to appeal. Give new medical facts showing why implants are needed.

Q: Are there cheaper ways to replace teeth Fidelis might pay for?

A: Yes. Dentures and bridges are paid for more often and cost much less. Ask your dentist about these choices.

Summary: Key Points to Remember

• Fidelis Care dental implant coverage depends on your plan, your needs, and—mostly—if your dentist proves you really need them.
• Medical need is a must. Just wanting to look better won’t work.
• Pre-authorization is needed—don’t start until Fidelis says yes.
• Dental implants cost a lot. Even with Fidelis, you’ll probably pay some part yourself.
• In-network doctors and professional labs can help guide you through the steps for best results.
• Always check other choices, ask about payment plans, and know you can appeal a denial.
• Your teeth and health matter. Take it one step at a time and don’t be afraid to ask questions.

If you follow these steps, you’ll have the best chance at getting the dental care you need—without any big surprises. And remember—keep smiling!