Yeoksam-dong Dental Clinic: How Much Insurance Coverage Is Available for Implants for Those Aged 65 and Over? (Whether Indemnity Insurance Can Cover It)

Yeoksam-dong Dental Clinic: How Much Insurance Coverage Is Available for Implants for Those Aged 65 and Over? (Whether Indemnity Insurance Can Cover It)

Hello. I am Kim Hangyeol, director of Smileview Dental Clinic, and I have provided implant and comprehensive dental care for many years.

Many people are looking into implants for their parents or are approaching age 65 themselves and wondering whether insurance coverage is available.

"My mother needs an implant, and I heard that it is covered by insurance."

"If national health insurance applies, can I also file a claim with my indemnity insurance?"

These are questions we receive very frequently during consultations.

Because national health insurance and indemnity insurance have different eligibility criteria, many people become confused when they assume they are covered in the same way.

Today, I will discuss national health insurance and indemnity insurance for implants for those aged 65 and over, focusing on the questions we frequently receive in the consultation room.

An implant is not simply a treatment for placing one tooth.

Because the treatment must also take into account the remaining teeth, gums, and how long they can continue to be used, it is important to establish a treatment plan before considering insurance coverage.

For this reason, when planning treatment, we first check the following three things.

• We examine the overall oral condition and the condition of the jawbone together to establish a treatment plan.

• Rather than recommending implants alone, we also assess the condition of the gums and surrounding teeth.

• We explain the scope of insurance coverage and the treatment process in sufficient detail so that you can decide whether to proceed with treatment.

Can those aged 65 and over receive national health insurance coverage for implants?

National health insurance does not apply under the same criteria in every case simply because someone is aged 65 or over.

At present, national health insurance is known to apply to implants intended to restore chewing function. However, there are certain criteria, including a lifetime limit on the number of covered implants and eligibility for patients with partial edentulism rather than those who have lost all their teeth.

In addition, covered and non-covered items may be included together depending on the materials used and the treatment process, so it is necessary to first confirm eligibility through a consultation.

Whether insurance coverage applies may vary depending on the criteria, but the treatment plan itself should be based on the current condition of your teeth.

I believe it is more important to establish a plan that allows the teeth to be used for as long as possible, rather than changing the treatment direction because of the cost.

If national health insurance applies, can I also file a claim with indemnity insurance?

Many people also wonder whether they can file an indemnity insurance claim for their out-of-pocket expenses after national health insurance has been applied.

However, indemnity insurance policies may differ in whether and to what extent dental treatment is covered depending on the time of enrollment, the product, and the policy terms, so it is difficult to give a blanket answer.

If you are planning treatment, it is advisable to first check whether national health insurance applies and then confirm which items are covered by your indemnity insurance or dental insurance policy.

Insurance is a system that can help with treatment, but it does not make every decision on your behalf.

Checking the scope of coverage in advance may reduce the financial burden, but it is more important to decide on treatment in a way that suits the current condition of your teeth.

What should you do if you are not eligible for insurance coverage?

If you are under 65 or have already used the full number of implants covered by national health insurance, you may not be eligible for national health insurance coverage.

However, depending on whether you have indemnity insurance or dental insurance, partial coverage may be available, so it is advisable to check the terms of your insurance policy.

Regardless of insurance eligibility, the priority is to receive a diagnosis of whether an implant is truly the most suitable treatment after also examining the current condition of the jawbone and the bite of the surrounding teeth.

Rather than choosing treatment according to insurance criteria, finding the method most suitable for your current oral condition often leads to a result that can be used for longer.

I believe the standard for treatment should be the condition of your teeth, not your insurance coverage.

What ultimately matters about implant insurance?

Implant insurance is a system that may help reduce the financial burden of treatment.

However, it may not be advisable to decide on treatment simply because it is covered by insurance or to postpone treatment simply because it is not covered.

Ultimately, the most important thing is to receive an accurate diagnosis of which treatment is appropriate for the current condition of your teeth and gums.

When considering treatment, you should think first about achieving a result that can be used for a long time rather than focusing on the cost.

It is more important to establish a plan that allows a treated tooth to be used comfortably for as long as possible.

If you are preparing for an implant consultation, I hope you will first check not whether it is covered by insurance, but whether it is the most suitable treatment for your teeth right now.

Simply confirming that one point can make the direction of your future treatment much clearer.

The choice is always yours.

Thank you for reading this long post.

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Shin Nonhyeon Station Smileview Dental Clinic
Monday–Wednesday, Friday (10:00–18:30); Saturday (10:00–15:00) ​ * Closed Thursdays, Sundays, and public holidays
TEL: 0507-1398-7529

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