Does Medicare Cover Dental Implants?

Does Medicare Cover Dental Implants?

While Medicare plans do not generally cover dental care, which includes dental implants, they may cover some of the costs that are associated with dental implants. Because there are a variety of different Medicare plans, it can be confusing to determine what is covered and what isn’t. The first step toward understanding what might or might not be covered is understanding the dental implant procedure itself.

Dental implants are small cylinders, usually made of titanium, that are implanted directly into the gums and support permanent dental crowns or dentures. Because the implant is placed into the bone, these dental restorations are securely rooted and look and act very much like natural teeth, making them one of the most popular dental restoration options for people who are missing one or more of their natural teeth. As they heal, dental implants fuse together with the bone, which can take several months; the duration of dental implant treatment can include several different types of smaller procedures, prescriptions, and related diagnoses, and some of these adjacent costs may be covered by different types of Medicare.

The first step in a dental implant treatment plan is the initial evaluation or consultation, in which you and your dentist will discuss your treatment plan and determine the best course of action for your specific needs. If you and your dentist decide to begin dental implant treatment, you will undergo a few separate procedures, including the placement of the implant, the subsequent placement of the abutment, which attaches the implant to the dental prosthetic, and the placement of the prosthetic itself. You will also need to meet with the dentist periodically for follow-up examinations and aftercare. At your initial consultation, ask your doctor for a complete explanation of the various costs that can be associated with dental implants. As with any medical procedure, the cost of dental implant treatment can be expected to vary widely. Cost of implants is affected by geographical location, the health of the patient, the number of implants needed, and the materials and equipment used for your implant procedure. The dental implant fixture itself, which is the piece that is implanted in the jaw, usually costs between $1,000 and $3,000. The additional pieces, which often include an abutment that affixes the prosthetic to the implant and also the prosthetic itself, can cost anywhere from $500 to $3,000. A single implant can cost upwards of $3,000, and, when patients need a full set of implants, the cost can sometimes exceed $30,000.

While Medicare Part A and Part B, the original Medicare, does not cover any routine dental services, nor does it cover dental implants, some Medicare Advantage plans may include routine dental care. Medicare Part C offers patients the option of private insurance coverage through an approved health insurance provider, and some of these plans include routine dental care and coverage for prescription medication. If you’re interested in Medicare Advantage, research the plans that may cover dental services, which may include dental implants; with these plans, patients pay the Original Medicare Part B premium while also paying any additional premiums charged by the Medicare Advantage provider. Medicare Advantage plans may have limitations in coverage, as they are often either HMO or PPO plans, but they may offer additional coverage that makes this trade-off worth it. Some Medicare Advantage plans will cover dental implants, and many provide coverage for routine dental care that includes parts of the implant treatment process without covering the entire process itself. Medicare Advantage is a bit more complex than Original Medicare, but with the thorough research, patients can sometimes find coverage for dental implant treatment, so be sure to thoroughly investigate all available options if you’re interested in Medicare Advantage.

Although Medicare Part A doesn’t cover dental procedures, it does cover hospital care. While it is uncommon to have a dental implant procedure performed in a hospital, some related procedures may be performed in a hospital setting, and, in certain circumstances, some patients may need to have a dental implant procedure performed in a hospital. Medicare Part A may also cover dental checkups and dental care that is required before certain surgeries, like kidney transplants and heart valve replacements, though each hospital can vary; be sure to check with your hospital before undergoing any procedure.

Medicare Part D, which is offered by private companies and is purchased separately from Original Medicare, does provide patients with prescription drug coverage, though benefits may be limited to certain coverage areas or additional limitations. Prescription medications for dental implants, including pain medication and possible antibiotic medication, will likely be covered by a Medicare Part D plan, though you will need to confirm this with your individual provider. Medigap plans, which are also called Medicare Supplement Plans, are insurance plans offered through private providers that can cover associated fees, like deductibles and copays. While these plans won’t cover dental implants directly, they can help cover deductibles when any part of the procedure is performed in a hospital.

Because the options for Medicare coverage for dental implant treatments are limited, you may want to research your options for a private dental plan. If you’re investigating private dental plan options, check to see if dental implants are included in coverage as many private dental insurance plans do include dental implant procedures. If this isn’t an option for you, talk to your dentist about alternatives to dental implants. There are many options available for most patients, including removable partial dentures, resin-bonded bridges, and fixed-tooth bridges, that are more affordable than dental implants and may be suitable for your needs. While these options are also unlikely to be covered by Medicare, they may be covered by Medicare Advantage, and they are considerably more affordable than dental implants and may be better suited to your budget while still providing effective options for replacing missing teeth. Take into account your own clinical needs and financial resources as you investigate the options that exist for dental coverage, including coverage of dental implants, and, with informed research, you will find a dental restoration option that will work for you.