If you have lost a tooth due to an accident or other reasons, you might be considering dental implants. Unlike dentures which typically are used to replace several or even all your teeth, a dental implant can be used to replace a single tooth. The artificial tooth is permanently joined to your jawbone, usually using a titanium screw and abutment device. Today’s dental implants look almost identical to a natural tooth, and they can be an excellent option for those who are missing teeth and need this dental service. You might be wondering whether Medicare will cover the cost of a dental implant. Keep reading to get all the details on Medicare’s dental coverage.
Does Medicare Cover Dental Implants?
So, does Medicare pay for dental implants? Unfortunately no, Original Medicare does not cover dental implants. Similarly, Medicare does not cover dentures. The Medicare laws do not allow for Medicare to cover any routine dental care, like cleanings, tooth extractions, fillings, crowns, or dental implants. If you are enrolled in Original Medicare only, then you will basically have no dental benefits. Many people wonder, “Does Medicare cover dental?” The answer is no. There are a couple of exceptions to this rule. Medicare will pay for dental services that are medically necessary as part of another procedure. For example, suppose that you are in an accident and require emergency jaw surgery. If a tooth extraction is required to perform the jaw surgery, then Medicare will pay for the extraction.
Similarly, Medicare Part A will generally pay for an inpatient hospital stay that results from dental services. Suppose you undergo oral surgery and require a stay in the hospital due to the surgery. While Medicare will not cover the oral surgery, it will likely cover the stay in the hospital. Medicare will also cover certain oral screenings or exams that might be required for kidney surgery or heart valve replacement.
Dental Coverage With Medicare Advantage
If you have a Medicare Advantage plan, you likely have a Medicare dental plan included with your coverage. Medicare Advantage plans are managed by private insurance companies, and those companies are allowed to set their own rules when it comes to premium amounts, coverage details, and out-of-pocket expenses. However, they must offer at least the same minimum level of coverage as Original Medicare. Many people choose a Medicare Part C or Advantage insurance plan because most of these plans offer additional benefits beyond traditional Medicare coverage. These extra benefits often include vision and dental coverage plus other benefits like gym memberships.
If you have a Medicare Advantage plan, you should check your plan details to determine whether dental insurance is included. Most of these plans include dental coverage, but their coverage details vary. They have different monthly premium amounts, deductibles, coinsurance amounts, and copayments. While your dental implant procedure will likely be covered by your Advantage plan, the amount you have to pay will vary depending on which plan you have. Most Advantage plans also have an annual maximum for dental benefits. Most plans limit the amount they will pay each year to $1,000 or $1,500. This means that they will not pay more than this amount. So, if your procedure costs more than this, you will be responsible for the difference. You will likely also be required to pay a coinsurance amount of 20% to 40% of the procedure’s cost.
Will Medigap Help Pay For Dental Implants?
Many people choose to enroll in Medigap or Medicare supplement insurance. This insurance helps pay for out-of-pocket costs not covered by Original Medicare. These costs can include deductibles, copays, and coinsurance amounts. However, Medigap will not pay for dental implants. Since dental implants are not covered by Original Medicare, your Medigap plan will not cover them either. Medigap can only be used to pay for items that are covered by Medicare but require an out-of-pocket expense. For example, if you visit the doctor and are required to pay a $25 copay under your Medicare Part B coverage, your Medigap plan might cover your copay amount.
You should also know that you cannot be enrolled in both a Medicare Advantage plan and a Medigap plan. If you choose to enroll in one type of plan, you cannot also enroll in the other. So, if you have a Medicare Advantage plan that covers dental implants, you cannot be enrolled in a Medigap plan. That means that you will still need to cover all of the out-of-pocket expenses associated with the procedure that are not paid by your Advantage plan.
Medicare Part D Coverage For Dental Medications
Some people choose to enroll in Original Medicare and add a Part D prescription drug plan. Others have a Medicare Advantage plan that includes prescription drug coverage. If you have a Part D drug plan, that plan will likely pay for medications that you need for your implant surgery. This includes antibiotics, pain medication, or other medicines that might be necessary for the treatment of your dental needs. Medicare beneficiaries might not have dental implant coverage with their Original Medicare plan, but they will likely have the medications associated with this procedure covered under their Part D plan if they have one.
As with Medicare Advantage plans, Part D plan coverage details also vary from one insurance company to the next. Different plans are likely to have different copays and coinsurance amounts, and each plan has different details about which medications it will cover. If you need help selecting the right Medicare plan for your needs, you should consult a licensed insurance agent in your area. An agent can help you select the right health insurance plan for your needs, and the right plan should help to lower your overall health care costs. If you are looking specifically for dental plans that cover implants, they can assist you with that as well.
The Bottom Line
If you are wondering, “Will Medicare pay for dental implants,” the answer is no. Original Medicare does not cover basic dentistry services like cleanings and fillings, and it also does not cover dental implants. Some people choose to add a standalone dental insurance plan to their coverage, while others might opt for a Medicare Advantage plan that includes dental coverage. The cost of dental implants can be well over $1,000 without dental insurance, although the right dental plan can significantly lower this cost. The replacement teeth used in today’s implants are extremely realistic, and most people could never tell that it was not a natural tooth. If you need additional coverage to help with the cost of implants, you should consider a Medicare Advantage plan or a separate dental insurance plan.
Frequently Asked Questions
What is a dental implant?
A dental implant is an artificial tooth that is permanently attached to your jawbone. Typically, a titanium screw is inserted into the jawbone approximately where the tooth roots from the missing tooth were located. An abutment device is then placed over the screw, and the tooth is attached to the abutment. The placement of the implant is a surgical procedure since the screw is inserted into the bone. Today’s implants look extremely realistic, and most people find that they look, feel, and act like natural teeth. Dentistry work is important to a person’s overall medical care, and getting a dental implant can be the right decision for many people.
What is the cost of a dental implant?
The average cost of a dental implant ranges from $1,500 to $5,000 for a single implant. If a bridge or other work is necessary, that cost will increase. With dental insurance coverage, you can expect to pay approximately 40% of the cost in most cases. So, an implant is likely to cost you anywhere from $400 to $1,500 in that case. If additional services are needed, like additional X-rays, additional dental work, or other items, then the cost of the procedure will increase. Remember that an implant is a surgical procedure, so this includes the cost of the surgery, anesthesia, implant, and other items associated with the work.
What are the advantages of having an implant that is covered by Medicare?
The biggest advantage of having an implant covered by Medicare is the fact that it will cost you less money out of your pocket. A lot of people wonder, “Are dental implants covered by Medicare?” If you only have Original Medicare, you will not get an implant covered. However, if you have a Medicare Advantage plan that includes dental coverage, your implant procedure will likely be covered. In that case, your insurance plan will cover a large portion of the cost for you. You will only be required to pay your coinsurance amount or other out-of-pocket costs required by your plan. This can save you a significant amount of money.
