Does Ameritas Cover Dental Implants? Plans, Maximums, and Exclusions

Ameritas does cover dental implants under most of its plans, typically paying 50% of the cost as a major (Type 3) service after a $50 deductible, though first-year coverage is often lower, one plan excludes implants entirely, and several policy clauses can reduce what Ameritas actually pays. The exact benefit depends on which plan you have, how long you’ve been enrolled, and whether the tooth being replaced was lost before or after your coverage started.

Which Plans Cover Implants and at What Percentage

Ameritas sells individual coverage through its PrimeStar plans and also administers employer group plans. Among the five PrimeStar tiers, implant coverage breaks down like this:¹²

PrimeStar Lite does not cover implants at any point.
PrimeStar Boost covers implants at 20% in-network in year one, rising to 50% in-network after year one. Out-of-network starts at 10% and rises to 30%.
PrimeStar Complete covers implants at 20% in-network in year one and 50% in-network after year one. Out-of-network starts at 10% and rises to 40%.
PrimeStar Access covers implants at an estimated 50% in-network and 30% out-of-network.
PrimeStar Total covers implants as a major service at an estimated 50%.

The first-year reduction on the Boost and Complete plans is the trap most buyers miss. If you enroll specifically because you need an implant soon, you’re looking at 20% coverage, not 50%. On a $5,000 implant, that gap is $1,500 before anything else is factored in.

Employer group plans are a separate question. Group benefits depend on what the employer bought, so annual maximums, cost-sharing, and waiting periods vary.³ Some group plans exclude implants outright. One published employer plan excludes initial prosthetic placement unless the tooth was extracted while that specific plan was active.⁴ A machinists’ union plan treats implants as a covered Type 3 service under its Premium and Plus tiers but excludes them under its Preventive tier.⁵ If you have group coverage, the only reliable source is your own certificate of coverage.

Coverage can extend to the main components of implant work: the surgical placement, the abutment, and the crown, with the specifics depending on the plan.⁶ Bone grafting, when medically necessary, is generally treated as a major service and covered at the same percentage under plans like PrimeStar Boost and Complete.⁷ Extractions and ridge preservation are often included as well.

Annual Maximums Cap What You Actually Receive

A 50% coverage rate only matters up to the plan’s annual maximum. A single implant in the United States typically runs $3,000 to $7,000,⁸ which means the cap often bites before the coinsurance does.

PrimeStar annual maximums, which increase after year one:¹²

PrimeStar Lite: $750 year one, $1,500 after.
PrimeStar Boost: $1,500 year one, $2,000 after.
PrimeStar Complete: $2,500 year one, $3,000 after.
PrimeStar Access: $1,000 year one, $2,000 after.
PrimeStar Total: $2,000 year one, $2,500 after.

All PrimeStar plans carry a $50 deductible that applies to Type 2 and Type 3 services, including implants.¹ Group plan deductibles may differ.

Exclusions That Can Shrink or Eliminate Your Benefit

Four policy provisions deserve attention before you schedule anything.

Missing Tooth Clause

Many Ameritas plans include a missing tooth clause: the plan will not pay for a prosthetic replacing a tooth that was already gone when your coverage started.⁹ If you lost the tooth two years ago and enrolled in Ameritas last month, the implant may not be covered at all. Some group plans tighten this further by requiring that the extraction itself happened while you were covered under that plan.⁵ Plans with full prior extraction coverage waive this restriction, which is why the certificate of coverage, not the brochure, is the document to check.

Alternate Benefit Clause

Ameritas plans may apply a “least expensive alternative treatment” rule. If a cheaper procedure could reasonably treat the same condition, the plan pays what the cheaper option would have cost.¹⁰ For implants, this often means Ameritas benchmarks its payment to a bridge or denture.⁵ You can still get the implant; the plan’s share is just based on the less expensive treatment.

Cosmetic Procedures

Implants done for purely cosmetic reasons are not covered. Coverage requires that the implant be medically necessary to restore chewing function or oral health.³ Ameritas states that most dental insurers do not cover cosmetic work “unless the dentist indicates it is medically necessary.”¹¹

Replacement Within Five Years

Replacement of a crown, denture, or other prosthetic within five years of its last placement is excluded, unless the replacement is needed because of an accidental injury that occurred while you were covered.⁵

In-Network Versus Out-of-Network

Staying in-network matters twice over. Ameritas network dentists have agreed to charge 25% to 50% less than their standard rates.¹²¹²

Out-of-network dentists are not bound by contracted rates, so they can balance-bill the difference between their charge and what Ameritas pays. That can push out-of-pocket costs higher and burn through your annual maximum faster.¹³

A Realistic Cost Example

Take a $5,000 implant, in the middle of the typical $3,000 to $7,000 range.⁸ Under PrimeStar Complete after year one, with 50% in-network coverage and a $3,000 annual maximum, Ameritas pays $2,500 and you pay $2,500, assuming you haven’t used the maximum on other work. If that same implant happens during year one, when the plan pays only 20% in-network, Ameritas pays $1,000 and you pay $4,000.

Under PrimeStar Boost after year one, with a $2,000 annual maximum, the 50% share on a $5,000 implant would be $2,500, but the plan tops out at $2,000, so your share is $3,000. If the alternate benefit clause applied and the plan paid as if a bridge were the treatment, the payment could be lower still. These figures assume in-network pricing; out-of-network, higher charges and lower coinsurance both work against you. Bone grafting, averaging around $600 but sometimes higher, is a separate charge.⁸

How To Confirm What Your Plan Will Pay

Benefits vary by state, by employer, and by plan year. Ameritas directs members to the certificate of coverage in their online account for the authoritative details of their specific plan.⁹

Ameritas does not require pre-authorization, but it recommends that your dentist submit a pretreatment estimate before expensive work like implants.⁹ The estimate tells you, in writing and based on your actual plan, what Ameritas expects to cover and what you’ll owe. It’s not a guarantee of payment, but it’s the one document that accounts for the missing tooth clause, alternate benefit rules, annual maximum status, and network pricing all at once.¹⁴ For a procedure in the $3,000 to $7,000 range, it’s the step worth taking before you sit in the chair.

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