Updated April 13, 2022
Reading time: 4 minutes
If the eyes are the gateway to your soul, the mouth is the gateway to your health.
Dental care is vital to a healthy body and healthy aging. But dental services are expensive, making it hard to get Medicare coverage for dental care. Insurance plans across the spectrum have complicated rules about dental work coverage. That’s whether you have Medicare, Obamacare, or independent health care.
In this article, we will discuss how Medicare treats dental implants. Plus will show you the best way to get your dental implants covered. Let’s get started!
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Dental implants are a popular and permanent way to replace lost teeth. They are a popular though expensive alternative to dentures. They work by inserting a screw in place of the root of your tooth. Once the screw is acclimated to your jaw, it is capped with a crown. The metal screw fuses with your jawbone and can strengthen your oral health overall. Dental implants look and feel like your natural teeth.
For patients needing all their teeth replaced, dentures on implants are available. There are many types of dentures on implants, including:
Whatever type of dental implant you need, the complicated process is expensive. The process often includes oral surgery and extensive follow-up care. You will also need to spread the procedure out over several weeks and several office visits. This allows time for the jawbone and metal to fuse.
Dental implants cost anywhere from $1,500 to $25,000 depending on your oral health condition.
Medicare and dental implant coverage is tricky. Remember that Medicare was not designed to cover routine care we’re used to pre-Medicare. Even so, there are many ways to work around coverage issues.
Original Medicare does not cover dental implants. But all is not lost! You can purchase stand-alone dental coverage. Or you can find a Medicare Advantage plan that covers dental. (More on this below)
You’ll need to be enrolled in your plan for several months before you get dental implant coverage. Typically, this takes one year.
Expecting your dentist to prescribe painkillers? You’ll need good prescription drug coverage to help cover the cost of medications.
Medicare Advantage—also called Medicare Part C — is senior health insurance provided by private insurance companies and regulated by the federal government. Strictly speaking, your Medicare Advantage plan does not come with automatic dental coverage. However, many Medicare beneficiaries can add a dental plan to their MA plan at an affordable rate. Some MA plans may even offer discounts for bundling dental and vision coverage.
When looking at dental plans, read the fine print. Many plans have graduated coverage, with higher coinsurance in the first year. Gradually, the cost of coinsurance decreases. It may look like this:
|Year 1||50 percent covered, 50 percent coinsurance|
|Year 2||65 percent covered, 35 percent coinsurance|
|Year 3||80 percent covered, 20 percent coinsurance|
Original Medicare (Part A and Part B) and Medigap do not offer coverage options for dental benefits. That means you really have two options for dental procedures like implants:
Get a Medicare Advantage plan that covers dental
Get a stand-alone dental plan.
With either option, you’ll likely need to pay a monthly premium. Bear in mind that, even with insurance, dental implants are going to cost you. You’ll cover coinsurance, copayments, and deductibles. According to DentalAuthority.org, a single dental implant costs $4,500 on average. If your coinsurance is 20 percent, that means $900 is coming out of your pocket.
But that’s not all. Your dental plan could have a maximum annual benefit. This means that there is a cutoff on how much your dental insurance will cover in one year. For example, if your maximum annual benefit is $1,200, your insurance company will pay no more than $1,200. In the above scenario, you’d have to pay $3,300 out of pocket.
When shopping for dental coverage, look for generous and affordable coinsurance plans. Be sure to find a maximum annual benefit appropriate to your dental expenses. You can speak with your dentist about estimating the cost of the implants you need. You can also speak with one of our qualified insurance agents to help you find the plan that saves you the most.
Start with the Insurify Medicare comparison tool to help you find Medicare advantage insurance plans that offer dental. Just enter your ZIP code. Once you get to your results page, look at the menu on the left. Under “Plan Features” choose “Dental. Now you’ll only find plans that include dental. Compare options side-by-side to discover which plan is best for you. If you have additional questions, just speak with one of our licensed agents. Try now!
Original Medicare and Medicare Supplement insurance do not cover routine dental care. Overall, it is difficult to find yourself in a situation where your Medicare plan will cover. But, there are a few instances:
You need a dental exam before surgery, like a heart valve replacement.
You’ve sustained an injury to your jaw or mouth that results in tooth damage.
You’re undergoing treatment for oral cancer.
In all of these cases, you will be covered under Medicare Part A, which covers you for hospital visits. Bear in mind that this doesn’t mean you’ll get dental implants if you lose a tooth in an injury. Medicare Part A likely only covers the tooth extraction.
Additionally, follow-up dental appointments may not be covered under your Original Medicare plan.
According to the U.S. Department of Health & Human Services, “dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit.” However, Medicaid beneficiaries 21 and older are not universally covered. Each state primarily controls Medicaid. Some states have elected to offer dental care, while others have not. Be sure to speak with your Medicaid provider about your options.
There are many ways people can lose teeth: advanced tooth decay, failed root canal therapy, and periodontal disease (aka gum disease) are common culprits. A person might also break a tooth in an accident, and this often results in tooth loss. Dental implants are a permanent way to replace missing teeth.
Dental implants have many benefits, including quality of life benefits. Dental implants maintain the structure of your remaining teeth and improve chewing ability, and recipients of dental implants often report higher self-esteem. But it’s up to you if the costs are worth the benefits.
In general, Original Medicare does not cover dentures or denture fittings for Medicare beneficiaries. Some Medicare Advantage plans may have accompanying dental plans that include dentures or denture fittings. Those with Original Medicare can purchase separate dental insurance as well.
Planning is the key to saving. When planning for dental implants, it’s essential to know your timeline. How many teeth do you need to replace? What are the costs like in your area? Do you have any other dental or medical issues that might influence the costs of your dental implants? It’s a great idea to speak with your dentist (or a local dentist) to learn more about your expected expenses. Once you’ve gathered the information, you can review dental insurance plans and Medicare Advantage plans that offer dental coverage. Pay attention to the premium costs, maximum annual benefit, and coinsurance rate. You should also note any copays you’ll be responsible for. It may take some arithmetic, but you can find the plan that is overall most advantageous for your needs. Finally, look for ways to space out your implant surgeries, crown fittings, and follow-up care. Spreading treatment out over more than one year helps you get more of your treatment covered.
You’re not going to find a Medicare plan that covers 100 percent of your dental implant costs. But, you will likely find a dental plan that helps cover some of those costs. Plus, you’ll get additional benefits like an annual check-up, x-rays, and dental treatments.
When shopping for dental plans, be sure to note the:
Cost of premiums
Maximum annual benefit
Measure these against the expected costs of your dental needs to find the best plan for you. And don’t forget to use the Insurify Medicare comparison tool!
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J.J. Starr is a health and finance writer with a background in banking, lending, and financial advising. She holds a Series 6, FINRA, and life insurance licensure and a master's degree from New York University. Through her writing, she strives to use her decade of experience to help consumers make sound financial choices. Connect with J.J. on LinkedIn.Learn More