Does Medicare Cover Dental Implants?
Dental implants are dental restorations that replace lost natural teeth with prosthetic teeth that are affixed directly into the jawbone. The dental implant itself serves as a substitute root for a natural tooth and supports a dental crown or dental bridge, offering a stable and attractive option for people who are seeking to replace one or more missing teeth. While Original Medicare plans, Part A and Part B, do not cover routine dental care, nor do they cover dental implants, Medicare Advantage plans may cover routine dental services. While Medicare doesn’t directly cover dental implants, they may cover some of the costs that are often associated with dental implant procedures. Because the procedure for placing dental implants usually requires many different procedures performed over a period of time, there are multiple opportunities for patients to receive varying medical diagnoses that necessitate different types of procedures and that may each require specific types of medication. Medicare may cover some of these associated procedures, depending on the specific needs of each patient.
Along with the wide variety of possible procedures, the cost of dental implants varies widely. While the number of procedures required for each specific clinical is a significant factor when determining cost, the geographical location of the patient also affects cost, along with any specific medical conditions that may necessitate additional care or specific types of treatment, as well as the materials that are chosen for the manufacture of your implants and the equipment that is used in your procedure. The number of implants required for each patient’s specific treatment also affects overall cost. While there are some types of dental implants that use a third, separate piece, called an abutment, the two most complex elements of any dental implant are the implant fixture itself, and the dental crown or bridge that will be fixed to the healed abutment following surgery. Implant fixtures usually range in price from $1,000 to $3,000, while the cost of the crown or bridge ranges from $500 to $3,000. It is unlikely for the entirety of a dental implant procedure to cost less than $3,000, and treatment can cost substantially more. For patients who need to replace an entire mouth full of missing teeth, restoration with dental implants can cost $30,000 or more. While other types of dental restorations, including removable partial dentures or fixed-tooth bridges, may be less expensive than dental implants, they are also not likely to be covered by Medicare, though some may be covered, at least in part, by Medicare Advantage.
Patients who are covered by Medicare Part A receive coverage for treatments that occur in a hospital setting. While it is uncommon to receive dental implants in a hospital, there are parts of the implant procedure that may be performed in a hospital, and, for patients with certain health risks, the procedure may be performed in hospital settings. Medicare Part A tends to cover dental checkups and dental care that is required as part of a larger treatment plan, like organ transplants or heart valve replacements, though these do not often come into play when dental implant procedures are needed. In some cases, Medicare may pay for a patient’s admittance to the hospital while not covering dental care that is received there; it is imperative for each patient to check with the hospital and their own Medicare plan before seeking treatment.
Medicare recipients are provided with prescription drug coverage through Medicare Part D. Medicare Part D is offered by private insurance companies and must be purchased separately from the rest of the Medicare coverage. Medicare Part D may also be subject to other limitations that are unlikely to apply to Original Medicare. Dental implant procedures almost always involve prescription medication, either for pain relief, antibiotic treatment, or other purposes specific to your medical needs. It is highly likely that a private Medicare Part D plan will cover the medications required for your treatment, though it is important to check your own coverage before undergoing any medical procedure.
Supplemental Medicare plans, also known as Medigap plans, are privately provided insurance plans that can help cover deductibles, copays, and other costs that are left to the patient. Medigap plans usually don’t directly cover medical care, and they are unlikely to help with implant coverage, but Medigap plans can help cover deductibles for related procedures that are performed in hospitals and are covered under Medicare Part A.
Medicare Advantage is another Medicare feature that relies on private insurance. Also known as Medicare Part C, Medicare Advantage plans provide the same coverage as Medicare Part A and Medicare Part B, but they may also provide additional coverage. Many Medicare Advantage plans cover vision and dental care, while Original Medicare never includes visual or dental plans. Medicare Advantage plans, which are private insurance plans, are subject to the same types of limitations that are part of other private insurance plans. Medicare Advantage plans are either HMO or PPO plans, and they come with a narrower coverage area than Original Medicare; this narrower coverage is usually an acceptable price to pay for the additional coverage that Medicare Advantage plans may provide. Many Medicare Advantage plans offer dental benefits, including routine dental care like annual examinations and cleaning, and some plans may include more complex treatments like fillings, extractions, or restorations. Some Medicare Advantage plans cover dental implants, and some also provide dental care that may include parts of the dental implant process, though patients are usually required to use network providers and may have higher deductibles. Medicare Advantage may also charge a supplemental monthly premium for coverage that includes dental care. Medicare Advantage plans can be more complex than Original medicare, and researching options before choosing a plan is advisable. Because of the limitations in coverage for all types of Medicare, and because of the complexity of Medicare Advantage, many Medicare recipients elect to use private dental insurance plans, several of which cover dental implants. If you are missing one or more of your natural teeth, thoroughly researching your insurance options, including Medicare, can help you decide if dental implants are a realistic option for you.