Haris Ashley
Dental implants are a common procedure for those who need to replace missing teeth. While dental insurance can help with the cost, it's important to understand what your plan covers. Aetna, a popular dental insurance provider, offers various plans with different provisions. Some Aetna plans may cover dental implants, but others exclude them entirely. It's essential to review the specific details of your Aetna plan, including any limitations, exclusions, or missing tooth clauses, to determine if and to what extent dental implants are covered.
| Characteristics | Values |
|---|---|
| Dental implants covered | Depends on the plan. Some plans cover dental implants, while others exclude them. |
| Dental implant procedure | The surgical placement of the dental implant body is covered by some plans, but the restorative procedure (replacement of the missing crown) is considered a separate dental expense. |
| Bone grafts | Generally not considered medically necessary, except for clinically significant bony defects in patients aged 26 or older. |
| Routine dental care | Checkups, cleanings, X-rays, sealants, and fluoride treatments for children are typically covered at 100%, though some plans may pay less. |
| Fillings, root canals, gum treatments, and extractions | Most plans cover 60-80% of procedure costs. |
| Crowns, bridges, and dentures | Typically covered at 50%, but subject to provisions and restrictions such as missing tooth clauses, alternative minimum benefits, etc. |
| Orthodontic services | Some plans cover medically necessary orthodontic services for children and adolescents under a pediatric oral health benefit. |
| Cosmetic dentistry | Not covered by dental insurance. |
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What You'll Learn
Aetna PPO plans and dental implants
The Aetna Dental PPO plan offers both in- and out-of-network coverage. Preventive services such as checkups, cleanings, X-rays, and sealants are covered at 100%. The in-network annual maximum benefit is $2,000 per person, while the out-of-network annual maximum benefit is $1,500 per person, after an annual deductible of $50 for an individual or $150 for a family has been met.
Aetna's medical plans generally do not cover routine dental care, treatment, or replacement of teeth or structures (e.g. root canals, fillings, crowns, bridges, dental prophylaxis, fluoride treatment, and extensive dental restoration). However, some Aetna medical plans provide coverage for certain "dental-in-nature" oral and maxillofacial surgery (OMS) services related to the jaw or facial bones.
Dental implants are typically not covered under the medical plan, even if they accompany medically necessary reconstructive surgery. However, there may be exceptions specified in the certificate of coverage. For example, dental implants may be covered if they are necessary to stabilize a maxillofacial prosthesis, such as in cases of dental reconstruction due to medication-related osteonecrosis, radiation-induced osteonecrosis, or the removal of a tumor.
It is important to note that different Aetna PPO plans may have varying provisions, so it is recommended to review the specific details of your plan or consult with your provider to determine the extent of coverage for dental implants and other dental procedures.
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Medical plans and dental implants
Dental implants are a common procedure to replace missing teeth. They are designed to mimic the function of an artificial tooth root, with the size and shape fitting into the jawbone like a real tooth. The procedure has a high success rate, with up to 98% of implants retained for the patient's life. The process by which the body grows new bone around the implant is called "osseointegration".
Aetna offers a range of medical and dental plans, and the coverage for dental implants varies depending on the specific plan. Some Aetna PPO plans do not cover dental implants at all, while others may provide coverage under certain circumstances. It is important to carefully review the details of your specific plan, as limitations and exclusions may apply.
Some key points to consider regarding Aetna medical plans and dental implants include:
- Medical Necessity: Aetna medical plans generally do not cover routine dental care, treatment, or replacement of teeth. However, some plans may provide coverage for specific "dental-in-nature" oral and maxillofacial surgery (OMS) services related to the jaw or facial bones.
- Exclusions: Most Aetna plans do not cover the routine replacement of teeth through dental implants. Additionally, any adjunctive procedures, such as bone replacement grafts, sinus lift surgery, soft tissue grafts, and barrier membrane placement, are typically excluded from coverage.
- Pediatric Coverage: Some Aetna medical plans, including new and non-grandfathered plans subject to Patient Protection and Affordable Care Act requirements, cover medically necessary orthodontic services for children and adolescents under a pediatric oral health benefit. This coverage is intended for severe conditions, such as cleft palate or trauma involving the oral cavity, that require surgical treatment in addition to orthodontic services.
- Missing Tooth Clauses: Some Aetna PPO plans include "missing tooth clauses," which means that any teeth missing before the insurance was obtained will not be covered for replacement, including implants.
- Cost Coverage: While Aetna PPO helps with dental costs, the exact coverage depends on your specific plan. Some plans may cover certain procedures, like white fillings, at a higher percentage, resulting in varying out-of-pocket costs for different treatments.
- Plan Variations: Different Aetna plans have different provisions. Some plans may cover orthodontic treatment only up to a certain age, while others have no age restrictions. It is important to review the details of your specific plan to understand the coverage and limitations.
In summary, while some Aetna medical plans may provide coverage for dental implants under specific circumstances, it is not a standard inclusion. It is essential to carefully review the details of your chosen plan, including any exclusions, limitations, and "missing tooth clauses," to fully understand your coverage for dental implants.
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Medical plans and orthodontic services for children
The cost of orthodontic services for children can be significantly reduced with the help of a suitable medical plan. Some medical plans cover medically necessary orthodontic services for children and adolescents under a pediatric oral health benefit. These plans are often subject to Patient Protection and Affordable Care Act requirements.
Under these plans, comprehensive orthodontic services are considered medically necessary for children and adolescents who have a severe handicapping malocclusion related to a medical condition. Such conditions could include cleft palate, other congenital craniofacial or dentofacial malformations requiring reconstructive surgical correction, or trauma involving the oral cavity requiring surgical treatment.
Aetna's medical plans generally exclude dental services for the routine care, treatment, or replacement of teeth or structures. However, some Aetna medical plans provide coverage for certain "dental-in-nature" oral and maxillofacial surgery (OMS) services related to the jaw or facial bones. For example, Aetna may cover the cost of dental implants if they are necessary to stabilize a maxillofacial prosthesis such as an obturator.
Aetna also offers dental insurance plans that cover checkups, cleanings, X-rays, sealants, and fluoride for children. These services are typically covered at 100%, and the deductible does not apply. Some plans may pay less than 100%. Additionally, Aetna plans may cover fillings, root canals, gum treatments, and extractions at 60-80% of the procedure costs. Crowns, bridges, and dentures are typically covered at 50% but are subject to provisions and restrictions.
When choosing a medical or dental plan, it is important to carefully review the plan's details to understand what orthodontic services are covered and whether there are any age restrictions.
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Aetna's medical plans and dental exclusions
The range of services covered by Aetna's medical plans varies, and dental exclusions are not uniform across the plans. Aetna's medical plans cover dental services and oral and maxillofacial surgery to varying degrees. Some Aetna medical plans provide coverage for some dental-related services and certain "dental-in-nature" oral and maxillofacial surgery (OMS) services related to the jaw or facial bones.
Standard HMO and traditional plans cover the removal of tumors, treatment of dislocations, facial and oral wounds/lacerations, and removal of cysts or tumors of the jaws or facial bones, or other diseased tissues. Additionally, the reduction of any facial bone fractures is covered under all Aetna medical plans.
Some plans, including new and non-grandfathered plans subject to Patient Protection and Affordable Care Act requirements, cover medically necessary orthodontic services for children and adolescents under a pediatric oral health benefit. These comprehensive orthodontic services are considered medically necessary for conditions such as cleft palate, congenital craniofacial or dentofacial malformations requiring reconstructive surgical correction, and trauma involving the oral cavity requiring surgical treatment.
However, it is important to note that dental services for the routine care, treatment, or replacement of teeth or supporting structures (e.g., root canals, fillings, crowns, bridges) are generally excluded from coverage under Aetna's medical plans. Most medical plans do not cover the routine replacement of teeth via surgical placement of a dental implant body. Additionally, any procedures considered adjunctive to the placement of the dental implant body, such as bone replacement grafts or sinus lift surgery, are also typically not covered.
While Aetna's medical plans may cover dental examinations to detect infection prior to certain surgical procedures and diagnostic x-rays connected with services covered under the medical plan, the coverage of dental services is not comprehensive and varies depending on the specific plan. Members should refer to their plan documents for detailed information regarding applicable terms and limitations of coverage.
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Aetna Dental PPO and dental costs
The Aetna Dental PPO plan offers dental insurance for individuals and families, with varying costs depending on the specific plan chosen and the number of people insured. The monthly costs shown on the Aetna website are examples of their lowest monthly rates, and your actual cost may be higher depending on your chosen plan and the number of insured individuals.
Aetna Dental PPO covers a range of dental services, including check-ups, cleanings, x-rays, sealants, and fluoride treatments for children. The plan typically covers 100% of these services, although some plans may pay less. Most plans do not require a deductible for these services, and they are typically covered twice a year or once every six months.
For fillings, root canals, gum treatments, and extractions, most Aetna plans will cover 60-80% of the procedure costs. Crowns, bridges, and dentures are usually covered at 50%, but they are subject to various provisions and restrictions, such as missing tooth clauses and alternative minimum benefits.
Some plans may also cover orthodontic treatment, but this is often restricted to patients up to 19 years of age. Additionally, replacement of old fillings and crowns may be covered, even if done for mostly cosmetic reasons.
It is important to note that dental implants are generally not covered under the medical plan, except in specific circumstances outlined in the certificate of coverage. While some medical plans may cover the surgical placement of the dental implant body, the restorative procedure (replacement of the missing crown) is typically considered a dental expense.
Aetna also offers special perks and discounts with their dental plans, including exclusive offers from CVS Health®. Additionally, members can access an online cost estimate of services through the Aetna Health℠ app or the Aetna member website.
For specific details regarding your plan's coverage and costs, it is recommended to review your plan documents or contact Member Services.
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Frequently asked questions
It depends on your specific plan. Some Aetna PPO plans exclude dental implants altogether, while others cover them under certain conditions.
Aetna medical insurance may cover dental implants if they are deemed medically necessary, for example, in the case of reconstruction after the removal of a tumour. However, most plans do not cover the routine replacement of teeth via surgical placement of a dental implant body.
Some Aetna medical plans, including new plans and non-grandfathered plans subject to Patient Protection and Affordable Care Act requirements, cover medically necessary orthodontic services for children and adolescents under a pediatric oral health benefit.
No, dental insurance generally does not cover cosmetic dentistry. However, if old, unsightly fillings and crowns are being replaced, the replacement is frequently covered, even if done primarily for cosmetic reasons.
