Does Medicare Cover Dental Implants?

Does Medicare Cover Dental Implants?

Original Medicare does not cover routine dental, but you do have options.

Simply put, the answer is no. Original Medicare does not cover most dental services. Most Medicare Advantage plans - over 98% - cover routine dental services, though. And many plans include at least some coverage for dental implants.

There are also dedicated dental insurance plans you can buy, as well as a few other options to help pay for dental services. Let's dive in.

What Are Dental Implants?

Dental implants are a type of artificial tooth that is implanted directly into your gums. These artificial teeth function and look very similar to natural teeth, so they are a desirable option for many seniors. Dental implants are very secure and have many pros in their favor.

Because dental implants are more complex than dentures, the procedure of getting them implanted can take quite a long time. Because of this, there may be multiple procedure types, diagnoses, and drug prescriptions involved in the process. Although Medicare doesn’t cover your dental implants directly, it may cover some of the costs related to getting them implanted.

How Much Do Dental Implants Cost?

As with most procedures, the cost of dental implants can vary widely. Implants can cost more depending o which part of the country you are in, any specific health conditions you have that require additional care, or simply the specific materials and equipment being used during your procedure. Another major factor is how many implants you get.

There are two main components to a dental implant, and the cost of each can vary widely. The implant itself will likely cost somewhere between $1,000 and $3,000. However, implants also require an abutment or crown, and this can cost an additional $500 to $3,000. As you can see, the price range here is quite large. In general, the full cost for an implant from beginning to end will seldom cost less than $3,000 and can end up costing significantly more.

If you need a full set of implants, the cost could be upwards of $30,000.

What Are the Steps to Getting a Dental Implant?

When you get a dental implant, there will be several distinct stages that will be paid for as distinct procedures. First, you’ll have to get an evaluation or consultation, during which you will be advised about the best course of action to proceed with, and during which you can also ask about the price. After this, your doctor will have to insert the implant, followed by an abutment, and finally a permanent crown. Once your permanent crown is in place, your dental implant is complete!

Alternatives to Dental Implants

Whether you want an alternative to dental implants due to the price, or are simply not a candidate for having them work in the first place, there are several options to choose from. Removable partial dentures, fixed-tooth bridges, and resin-bonded bridges are among the options you have available to you if you opt to not get a full dental implant.

Although these options are generally cheaper than dental implants, they still won’t be covered by Medicare. However, some may be covered partly or in full by Medicare Advantage.

Medicare Part A: Getting Dental Implants in a Hospital?

Medicare Part A covers your care in a hospital setting. Although it’s rare to get dental implants done in a hospital, some parts of your care may be done in a hospital setting. Additionally, you may need to get the operation performed in a hospital under certain circumstances. In general, Medicare Part A will cover some dental checkups and dental care, notably prior to a kidney transplant or heart valve replacement, but this will not apply to your dental implant procedure.

If you do get part of your procedure or diagnosis in a hospital, this doesn’t necessarily mean that Medicare will pay for it. Medicare may pay for your hospital admittance, without actually covering the dental care that you receive there. If you can, try to double-check this with the hospital beforehand.

Part D: Prescription Drug Coverage For Dental Implants

Medicare Part D provides you with prescription drug coverage. Unlike Original Medicare, Part D is offered by private insurance companies and has to be bought separately from the rest of Medicare. It also may be subject to coverage areas and other limitations that don’t apply to Original Medicare.

Getting dental implants will involve a prescription for pain relief medication following the procedure. You may also need another type of prescription medication specific to your condition or situation. Your private Medicare Part D plan will almost certainly cover the required medications. However, as always with private plans, you should double-check your coverage before the procedure.

Can Medigap Plans Help With Dental Implant Coverage?

Medigap plans, also known as Medicare Supplement Plans, are private insurance plans that help cover fees that Medicare usually leaves to you, like deductibles and coinsurance payments. Medigap plans don’t directly cover most medical care, and won’t directly help with your dental implant coverage. However, if you do have parts of your dental implant procedure done in a hospital, your Medigap plan can help you cover the Part A deductible.

Medicare Advantage: Does it Cover Dental Implants?

Medicare Advantage, also known as Medicare Part C, is a way to get your Medicare benefits through a private insurance company. All Medicare Advantage plans have to provide at least the same coverage as Part A and Part B, but many also provide additional coverage. It isn’t uncommon for Medicare Advantage plans to cover vision and dental care, which are never covered by Original Medicare.

Because Medicare Advantage plans are private insurance plans, they are subject to a lot of the same limitations as other private insurance plans that you may be used to. These plans will be either HMO or PPO plans, and your overall coverage area will not be unlimited as it is with Original Medicare. This is a trade-off that many people are happy to make because Medicare Advantage plans often offer this additional coverage.

There is no way to tell in advance whether a Medicare Advantage plan will cover dental implants. However, some plans do provide this coverage, and many plans provide routine dental care which may also cover parts of the dental implant process, even if the entire procedure isn’t covered. Using Medicare Advantage can be a bit more complex than Original Medicare, so make sure to weigh your options overall before you make a final decision.

Private Health Insurance Options

As you can see, the options for dental implant coverage by Medicare are limited. While you may be covered by a Medicare Advantage plan, these plans have other qualities that may make them less desirable for you. A final option to consider is a private dental plan. Due to a lack of dental coverage, many seniors use a private dental plan anyways. If you do, check to see if they cover dental implants -- many dental insurance plans do.

Dental Implants: Where to Go Next?

If you’re considering dental implants, you have many options to choose between for coverage. The main thing to keep in mind is that you will not be covered by Original Medicare, and will have to find an alternative way to get your procedure covered. Although Medicare may cover parts of your procedure, this is an outlier condition that you shouldn’t expect.

Whether you end up choosing a Medicare Advantage plan, a private dental plan, or simply an alternative to dental implants that you can pay for out of pocket, there are a lot of options on the table. Because of this, it’s important to understand your options, priorities, and financial resources before you start looking for plans, so that you find an option that works perfectly for you.

DONNA FREDERICK
After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.

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