Are Dental Implants Covered by Delta Dental?

Your Friendly Guide to Understanding Your Implant Benefits, Coverage Limits, and Costs

That first moment your dentist says you might need dental implants, you probably have two thoughts:

“Will this finally let me eat, talk, and smile normally again?” and right after, “But… will my insurance pay for it?”

If you use Delta Dental, you’re not the only one with that worry. People wonder about dental implant coverage all the time. If you’re lost about what’s covered (and what’s not), don’t stress—you’re in the right place. Let’s make this easy to understand together.

In This Article

• Are Dental Implants Covered by Delta Dental? The Quick Answer
• Why Coverage Varies So Much: Types of Delta Dental Plans
• What Affects Your Implant Benefits: Factors To Know
• Which Parts of a Dental Implant Procedure Might Be Covered
• How To Check YOUR Exact Coverage—Step by Step
• Smart Ways to Manage Dental Implant Costs
• Are You a Candidate for Implants—and Insurance Coverage?
• The Big Takeaways: Your Path Forward With Delta Dental and Implants

Are Dental Implants Covered by Delta Dental? The Quick Answer

Let’s answer the big question first:

Does Delta Dental pay for dental implants?

The honest answer: It depends. There isn’t a clear yes or no. Coverage changes depending on your exact Delta Dental plan, the work you need done, and your own situation.

Here’s the main stuff you need to know:

• Many Delta Dental plans now have some coverage for dental implants—but it’s usually partial, with limits and waiting times.
• Some plans don’t pay for implants at all, especially some individual and HMO-type plans.
• Most plans see implants as “major work,” which means you’ll pay a bigger part yourself than with basic dental services.

If you only remember one thing from this article, let it be this: Implant coverage isn’t the same for everyone, even if you both use Delta Dental. But don’t worry—we’ll make it clear.

Why Coverage Varies So Much: Types of Delta Dental Plans

Let’s see why your neighbor’s dental implant was covered but yours might not be! It all comes down to the Delta Dental plan you have. Here’s what that means:

1. Delta Dental PPO Plans

• These are the most popular. PPO means Preferred Provider Organization.
• Many PPO plans cover dental implants as “major” dental work (usually 30–50% after you pay your deductible).
• But, this only happens after a waiting time, and there’s often a yearly maximum—often $1,000 to $2,500 a year.
• In-network dentists are usually the cheapest option.

2. Delta Dental Premier Plans

• Like PPO, but with a bigger network of dentists.
• May also pay for implants, but what you pay depends on “usual, customary, and reasonable” (UCR) fees.
• Plans differ—a few offer better deals for major work like implants than others.

3. DeltaCare USA and HMO-Style Plans

• These plans are tighter with money. Dental implants might be not covered at all or very limited.
• You’ll probably have to see a set dentist from their list, and maybe need a referral for a specialist.
• Always look at your plan booklet or ask Delta Dental—don’t just assume you have coverage.

4. Individual vs Employer-Sponsored (Group) Plans

• Group plans you get from work usually give better coverage for implants, larger yearly maximums, and shorter waits.
• Individual plans (stuff you buy yourself) usually have tighter limits, longer waits, and may not cover implants at all.

Quick Recap Table: Delta Dental Plan Types & Implant Coverage

Short version? Always read your plan or call Delta Dental before starting any implant work!

What Affects Your Implant Benefits: Factors To Know

The details make a difference when it comes to insurance. Even if your plan says, “we cover dental implants,” you still need to check the details. Here’s what matters most:

1. Annual Maximums

Most Delta Dental plans have a maximum they’ll pay out each year. If your plan pays up to $1,500 a year and your implant process costs $4,000, you’ll have to pay anything over that $1,500.

2. Deductibles

This is what you pay before insurance helps (usually $50–$150 each year). Some plans set a higher deductible for major services.

3. Coinsurance/Copayments

Delta Dental often pays a part (say, 50%) after you pay your deductible. You pay the rest.

4. Waiting Periods

Many plans make you wait 6–12 months or even up to 24 months (on some individual plans) before they’ll pay for implants. Group work plans may skip this for new folks.

5. Medical Need vs. Cosmetic

Delta Dental will generally only pay for implants if you really need them for chewing, talking, or other reasons. Just wanting a nicer look usually isn’t enough.

Tip: If you can’t wear a removable denture because of mouth shape, allergies, or other reasons, get your dentist to document this for insurance.

6. Alternative Benefit Clause

Insurance loves cheaper options! Delta Dental might only pay as much as they would for a cheaper fix (like a bridge) if that works for your mouth, even if you really want (and get) the implant.

7. Exclusions

There’s always “what’s not paid for” in the small print. Some plans don’t cover certain types of implants (like mini implants) or bone grafts/sinus lifts. Always check.

8. Pre-Authorization / Pre-treatment Estimate

Before starting, your dentist sends details to get permission from insurance. This is super important. It tells you what Delta Dental will pay, what they won’t, and what you need to pay—before you agree.

> Pro tip: Most dentists say this is a must for big jobs. Don’t miss it!

Which Parts of a Dental Implant Procedure Might Be Covered?

Dental implants aren’t just one step—they’re made up of a few jobs. Here’s a look at each part and what might be covered:

1. Surgical Placement of the Implant

This is when the titanium post goes into your jaw, acting like a real tooth root.

Often covered as a major job (code D6010). Plans might pay 50%, with yearly maximums.

2. The Abutment

This piece links the post and the tooth on top (codes D6057 or D6058).

Many Delta Dental plans count this with the implant tooth, as major dental work.

3. The Crown or Prosthesis

This is the “tooth” you see.

Usually covered as major work (codes like D6065–D6069). Many plans pay about 50% after deductible.

4. Other Procedures

• Bone Grafts: Added if your jaw isn’t strong enough.
• Sinus Lifts: Sometimes needed for implants in your top jaw.
• Tooth Extractions: Taking out a tooth before replacement.
• Coverage? Big maybe. Some plans cover bone grafts like oral surgery (sometimes 80%); others don’t pay for them at all. Check your plan.

5. Diagnostic Services

• X-rays, Scans, Exams: Often covered on their own, but only up to yearly limits.

How To Check YOUR Exact Coverage—A Step-by-Step Guide

Getting the facts is key. Here’s how to find out “Will Delta Dental pay for my implant?” for you:

Step 1: Read Your Benefit Booklet or Plan Guide

• This has all the details! It tells you what’s covered, what’s not, maximums, coinsurance, waits, and the small print.

Step 2: Log into Your Delta Dental Online Account

• Find the latest plan info, print Explanation of Benefits (EOBs), and see claim updates.

Step 3: Call Delta Dental Customer Service

• Get clear answers. Ask things like:
• “Does my plan pay for implants, abutments, and crowns?”
• “What’s my yearly max and deductible?”
• “Do I have a wait before they’ll pay for implants?”
• “Do I need pre-approval?”

Step 4: Work With Your Dentist’s Office

• Dental offices handle insurance daily. Ask them to help you send in a pre-treatment estimate, using the right dental codes.

Step 5: Always Ask for a Pre-treatment Estimate/Pre-Authorization

• You’ll get a clear answer saying what Delta Dental will pay and what you owe. No shocks when you get the bill.

Smart Ways to Manage Dental Implant Costs

Say you find out you’ll have some (or lots) of the cost to pay yourself. Here’s how to make it a little easier:

1. Use In-Network Providers

• Staying in Delta Dental’s network can save you 25–50% on costs thanks to deals they’ve made.

Try finding an implant dental laboratory your in-network dentist suggests for repair work.

2. Watch Your Annual Maximum

• If you’ll hit your plan’s yearly limit this year, and you need more than one implant, see if you can spread the visits over two years.

3. Read Your EOB

• Check your Explanation of Benefits after each job. Make sure you weren’t billed for something not covered or by mistake.

4. Plan Ahead for Waiting Times

• If you just joined and have to wait a while, use this time for checkups and making a treatment plan.

5. Ask About Payment Options

• Many dental offices use payment helpers (like CareCredit).
• Some let you pay in small amounts over time.

6. Try Dental Schools or Discount Plans

• If you owe a lot, check out dental schools or china dental lab for making your tooth.

7. Appeal If Needed

• If a claim is denied and you and your dentist think it was needed, you can challenge it.

Are You a Candidate for Implants—and For Insurance Coverage?

Dental implants are great for a lot of people, but not everyone. Here’s what to know if implants could work for you, both for your health and for your insurance:

Who Makes a Good Candidate?

• Missing at least one tooth
• Healthy overall (no gum problems)
• Enough jawbone or willing to get bone added
• Ready to brush and care for them well

Insurance Stuff

• Implants are often approved for replacing a real need (if you can’t chew or talk right)
• If you lost the tooth a long time ago and get by with a bridge or removable denture, insurance might only pay for the cheaper choice.
• Small implants, “All-on-4” implants, or just for cosmetic looks may not be covered unless your plan says so.

Frequently Asked Questions About Delta Dental and Implants

Q: Does Delta Dental pay for all dental implants?

No—not every plan will, and it depends on your plan, waiting time, yearly max, and if the implant is really needed.

Q: Will Delta Dental pay for the crown and the implant itself?

Sometimes. The implant post, abutment, and crown are sometimes billed separately, and coverage depends on your plan.

Q: Are bone grafts and other steps before the implant covered?

Maybe. Some plans put them as major work; others don’t pay for them. That’s why you need a pre-treatment estimate.

Q: What is the Alternative Benefit Clause?

If a cheaper option (like a bridge) will work, Delta Dental might only pay what they would for that and not the whole implant bill.

Q: Can I use a payment plan?

Many dentists offer payments over time or use finance companies. If insurance doesn’t pay the full price, ask about this early.

The Big Takeaways: Your Path Forward With Delta Dental and Implants

Let’s wrap it up:

• Implant coverage is NOT the same for everyone. It depends on your plan.
• Be smart—check your plan, ask Delta Dental, and get a pre-treatment estimate before you begin.
• Don’t give up if you’re first told “no.” Ask, share health info, and appeal if you think it’s right.
• Use all the tips you can: in-network dentists, track your yearly max, split up payments, and look into payment options if needed.

What to do next:

Your smile is worth it. If dental implants fit your needs and keep your confidence high, there’s a way to get it done. Don’t let insurance confusion slow you down—take these steps, ask questions, and get the care you want!

References

• American Dental Association (ADA): Dental Implants
• Delta Dental Official Site: Understanding Dental Insurance
• Dental Economics: “Implant Insurance Coding and Reimbursement Tips”
• Journal of Prosthetic Dentistry: “Cost Effectiveness of Dental Implants vs Alternatives”

(These are general references; always check your own plan for exact coverage!)

Still have questions about dental implants, what they cost, and your options? Ask your Delta Dental provider or another dental expert for help just for you. Your way to a healthy, happy smile starts with good info—and now you have it!