Dental Implant Insurance Gap Calculator

Plan how much of a dental implant bill insurance will cover versus what you must fund out of pocket. Enter the comprehensive treatment quote, annual maximum still available, and coinsurance rate to see insurer payments after deductibles, remaining plan benefits, patient responsibility, and how far HSA or FSA balances stretch. Add optional discounts or deductibles to mirror your pre-authorization paperwork.

Estimated cost for the implant procedure including surgeon, restoration, sedation, and lab fees.
Unspent benefit remaining in your dental insurance annual maximum for the current plan year.
Percentage of eligible implant costs your plan pays after any deductible is satisfied.
Optional — defaults to $0.00 when blank. Enter remaining deductible owed before coinsurance applies.
Optional — defaults to $0.00 when blank. Subtract in-office discounts or dental savings plan reductions.
Optional — defaults to $0.00 when blank. Shows how much of the patient balance tax-advantaged funds can cover.

Insurance benefits vary by carrier and plan. Confirm waiting periods, exclusions, and reimbursement policies with your dentist and insurer before scheduling treatment.

Examples

  • Example 1 — $5,200.00 quote, $1,000.00 annual max, 50.00% coinsurance, $0.00 deductible, $0.00 discount, $2,000.00 HSA ⇒ Insurance pays: $1,000.00 (USD) | Patient out-of-pocket: $4,200.00 (USD) | HSA/FSA draw recommended: $2,000.00 (USD) | Remaining annual max after procedure: $0.00 (USD) | Insurance coverage of procedure: 19.23%
  • Example 2 — $3,800.00 quote, $1,400.00 annual max, 60.00% coinsurance, $150.00 deductible, $300.00 discount, HSA blank ⇒ Insurance pays: $1,350.00 (USD) | Patient out-of-pocket: $2,450.00 (USD) | HSA/FSA draw recommended: $0.00 (USD) | Remaining annual max after procedure: $50.00 (USD) | Insurance coverage of procedure: 40.91%

FAQ

How do I model treatment split across two plan years?

Duplicate the calculation with the next year's refreshed annual maximum and adjust the treatment quote to reflect procedures scheduled after the reset.

Does the calculator cover supplemental dental discount plans?

Yes. Enter negotiated savings in the discount field so the net quote reflects your reduced fee schedule before insurance pays.

What if implants are subject to a lifetime maximum?

Reduce the annual maximum input to the remaining lifetime benefit so the calculator caps insurance payments at the correct level.

Can I include bone grafting or anesthesia fees?

Add every fee into the treatment quote and adjust the discount input if some services are covered at different rates.

How can I reflect secondary insurance coverage?

Run the calculator once for the primary carrier, then subtract that payment from the quote and rerun it with the secondary plan's annual maximum and coinsurance settings to stack benefits.

Additional Information

  • Dental plans typically cap annual benefits, so once the maximum is exhausted the patient owes the remainder of the treatment cost.
  • Deductibles are treated as patient-paid amounts before coinsurance applies, and this tool caps them at the discounted treatment price.
  • Negotiated discounts reduce the treatment cost before insurance calculations, shrinking both insurer and patient shares.
  • HSA and FSA balances show how much tax-advantaged cash you can apply immediately toward the patient responsibility.
  • All amounts display in USD by default, yet the same workflow applies to any currency if inputs share the same unit.
  • Many implant plans enforce waiting periods or tooth-specific exclusions; confirm eligibility before finalizing a surgery date.

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