I caught an edge and faceplanted. My full-face helmet was at home; I was wearing a half-shell. Two front teeth were shattered. My health insurance said “We don’t cover dental.” My dental insurance said “We cap annual payouts at $1,500.” The implant quote was $8,000.
Key Takeaways
- The Dental Gap: Medical insurance covers the ER and stitching your lip. It rarely covers restoring the teeth. Dental insurance usually has very low annual maximums (
1kâ1kâ2k). - Medical Payments (MedPay): If you have MedPay on your specialty PEV policy, this is where it shines. It can pay the $6,500 gap for the implants as part of the “accident” coverage.
- Accidental Dental Riders: Some accident policies (like Spot) specifically cover “injury to sound natural teeth” up to the policy limit ($20k), bypassing the dental insurance cap.
- Full Face Helmets: The only financial guarantee against this is a chin bar.
The “Why” (Cosmetic vs. Essential)
Insurers often view implants as “cosmetic” or separate from medical health.
“Dental services are excluded except for… stabilization of the jaw.”
The Investigation: Paying the Dentist
I looked for money to fix a smile.
1. Dental Insurance (Delta Dental)
- Limit: $1,500/year.
- Reality: Pays for the extraction and a flipper (fake tooth). Doesn’t touch the implant cost.
2. PEV Insurance (Medical Payments)
- Limit: $5,000 or $10,000.
- Reality: This pays the dentist directly or reimburses you. This is the best use of the “Medical Payments” endorsement on a bike/board policy.
3. Aflac / Supplemental
- Reality: Pays a fixed cash amount per injury. Might give you $300 for a “broken tooth.” Helps, but doesn’t cover the bill.
Comparison Table
| Source | Covers Implants? | Limit |
| Health Insurance | No (Usually) | N/A |
| Dental Insurance | Yes | Low ($1,500) |
| Accident/MedPay | Yes | High ($10k+) |
Step-by-Step Action Plan
- Get the MedPay Add-on: It costs ~$5/month on your board policy. It is essential if you wear an open-face helmet.
- Code it Correctly: Ask the oral surgeon to bill it as “Trauma/Accident,” not routine dental work. Sometimes medical insurance will pick it up if it’s coded as reconstructive surgery from trauma.
- Wear a Full Face: A TSG Pass costs $300. An implant costs $4,000. Do the math.
FAQ
What if I broke my jaw too?
Health insurance usually covers the jaw surgery (bones). They just stop at the teeth.