Many older adults may develop oral health problems like gum diseases and tooth loss. That’s why most dentists recommend dentures or dental implants.
Compared to dentures, however, dental implants are more costly. Many seniors going through the Medicare sign-up process want to know – does Medicare cover dental implants?
This article will explain how dental benefits work under Medicare, specifically, dental implants. If you are just starting to learn about Medicare, you might be wondering what does Medicare cover?
Does Original Medicare cover dental implants?
Original Medicare does not cover dental implants. However, Medicare does cover dental services that result from illness or injury.
For example, Medicare may cover:
- Oral exams that are required as clearance for transplants or surgeryMedicare Part A will provide coverage if the oral exam is performed by a hospital dentist. However if the oral exam is done outside the hospital, Medicare Part B provides the coverage.
- Dental procedures resulting from oral cancer and face (or jaw) injuries
- If there are complications (e.g. infections) resulting from dental implants, Medicare will cover medically necessary care.
If you need coverage for dental implants, consider purchasing a standalone dental plan to cover the costs. Keep in mind, even with a dental plan, there may be coinsurance and a maximum annual benefit amount paid for dental coverage.
Do Medicare Advantage plans cover dental implants?
Around 97% of Medicare Advantage (MA), or Part C plans, cover dental care such as routine check-ups, oral prophylaxis, and x-rays.
Some Medicare Advantage plans cover more comprehensive dental procedures such as extractions, fillings, tooth replacement, or restoration and depending on the Medicare Advantage plan, some also cover dental implants.
If you are looking for dental implants it’s important to work with a licensed insurance agent to see if the plan you are signing up to covers the implants and at what cost. In addition, you should also make sure that overall plan suits your other health and medical needs (for example, it includes your primary care doctor in-network – otherwise you may end up with the dental care you want but not the the health care you need).
In addition, you should know that:
- Your dental implant procedure will need to be done within your plan’s provider network.
- Medicare Advantage plans will only pay for a fixed amount, regardless of the actual charges.
- Insurers may charge higher premiums to cover services beyond routine dental care.
- You can only switch into a Medicare Advantage plan during certain enrollment windows
What are the total costs covered by Medicare for dental implants?
A Medicare Advantage plan or standalone dental plan may pay for some but not all of the expenses associated with dental implants. You are responsible for copayments and coinsurance until the maximum annual benefit is reached. Plus, you will pay for the until the end of the coverage year.
If your Medicare plan doesn’t provide the necessary dental implant coverage, there are ways to manage costs:
- Get information about Medicare implant reimbursement under a Health Reimbursement Arrangement (HRA) if you are still employed.
- Check if dental implants are tax-deductible in your state.
Dental implants are expensive, time-consuming, and can be very painful. Therefore, consult your dentist to understand what dental fees will be covered by your insurance plan before going ahead with the dental implant procedure.
If you need dental implants covered by Medicare, the only current way is if you sign up to a Medicare Advantage plan that includes this as part of it’s benefits.
If you are looking help with a plan that covers dental – reach out to us at CoverRight.