Are dental implants covered by Medicare?

Curious about dental implants and Medicare coverage? This informative article explores the question of whether dental implants are covered by Medicare, shedding light on the nuances and considerations involved. Discover the role of Medicare Advantage plans in providing partial dental implant coverage and learn about the limitations of Original Medicare.

Understand the potential cost implications and explore alternative options to help you make informed decisions about your oral health. Take the next step towards securing the best insurance coverage by entering your zip code and comparing rates from top providers. Don’t miss out on the opportunity to find the right dental insurance that meets your needs and ensures a healthy smile.

Does Medicare cover dental implants regardless of your plan?

Original Medicare will not cover dental implants. Medicare Part A only covers hospital costs, and Part B only covers medical services. However, many Medicare Advantage plans do include dental insurance.

Medicare Part A will only cover your hospitalization if you need emergency dental surgery.

Also, the Centers for Medicare & Medicaid Services state that Part A may cover an oral examination in preparation of a procedure like renal surgery or a heart valve replacement surgery. However, a dentist on the hospital staff must do the exam in such a case.

Part B will cover dental procedures you need in preparation for other medical procedures, like radiation or the removal of a tumor. Also, Part B will cover an oral examination related to renal or heart valve replacement surgery if a physician does the exam.

Also, if you are wondering, “Can I get dental coverage from a Medigap policy?” Medigap plans do not offer dental coverage. These plans only supplement Original Medicare to cover out-of-pocket costs.

Getting an implant is an elective dental procedure, so only advanced dental plans will help you cover the costs. You must choose the right dental plan through Medicare Advantage (also known as Part C).

According to data from the Kaiser Family Foundation, 94% of Medicare Advantage enrollees have plans that include some dental coverage. However, many dental insurance plans do not include dental implant services.

Which Medicare Advantage plans cover dental implants?

The following dental insurance companies offer coverage for dental implants for seniors on Medicare.

Costs for Medicare Advantage Dental Insurance Partners That Offer Dental Implants

Note that even with this coverage, you are still responsible for paying much of the cost for your dental implants. On average, a single implant may cost you between $3,000 and $6,000.

You will also need to pay monthly, semi-annual, or annual rates for your dental plans, make Medicare Part B payments, and meet your deductibles.

How much does Medicare pay for dental implants?

Now, you must be wondering, “How can I get Medicare to pay for dental implants?” Unfortunately, Medicare does not pay for the procedure itself in any circumstance.

Even with a Medicare Advantage plan, Medicare itself will not directly cover your costs for dental implants. However, Medicare may pay for 30%-50% of the costs for any medically necessary oral surgeries related to your dental implant treatment.

For example, if you need to stay in a hospital after getting a dental implant, Part A will cover those costs. Part B covers corrective surgery if it promotes your overall health.

Case Studies: Dental Implants and Medicare Coverage

Case Study 1: Eligibility for Medicare Coverage

Mr. Johnson, a 68-year-old retiree, had been considering dental implants to replace multiple missing teeth. As he was covered by Medicare, he sought information regarding the potential coverage for this procedure. Upon consulting with his dentist and Medicare representative, Mr. Johnson learned that Medicare does not usually cover dental implants for routine dental care.

However, given his specific situation, where the loss of teeth was affecting his ability to eat and speak, his dental implants were deemed medically necessary. As a result, Medicare provided partial coverage for the procedure.

Case Study 2: Dental Implants as a Result of Accidental Injury

Mrs. Anderson, a 72-year-old Medicare beneficiary, suffered an accidental injury resulting in tooth loss. Her dentist advised dental implants for restoration. Medicare acknowledged the accident’s impact and approved partial coverage for the dental implant procedure as necessary medical treatment, improving Mrs. Anderson’s oral function and quality of life.

Case Study 3: Alternative Dental Coverage Plans

Mr. Ramirez, a 70-year-old Medicare recipient, required dental implants due to extensive tooth decay and tooth loss. Although Medicare did not provide coverage for dental implants as part of routine dental care, Mr. Ramirez had enrolled in a Medicare Advantage plan that included additional dental coverage. Through his Medicare Advantage plan, he was able to receive partial coverage for the dental implant procedure.

Case Study 4: Medicare Exclusions and Limitations

Ms. Lee, a 66-year-old Medicare enrollee, needed dental implants to address missing teeth but faced coverage denial from Medicare. Despite the impact on her eating and speaking abilities, she found out that dental implants are generally not covered by Medicare. This forced her to seek alternative ways to finance the treatment.

The Final Word on Medicare Dental Implants

Let’s review:

• Medicare will not directly cover dental implant procedures or materials.
• There are a limited number of Medicare Advantage plans that cover dental implants.
• Regardless of your dental plan, you will need to shoulder much of the cost.

Check with your primary dental care provider to know if any discounts are available. Some dental offices offer discounted prices for Medicare recipients. You may also enroll in separate discount programs or receive coverage from Medicaid if you live in a state that allows it.

Now that you know whether Medicare Advantage covers dental implants, are you ready to see rates from insurance companies that work with Medicare? Just enter your ZIP code into our free quote tool below to get started.