According to the Centers for Disease Control and Prevention (CDC), 26% of adults between 65 and 74 have lost all their teeth.
Nearly 3 million Americans have turned to dental implants and this number continues to grow by half a million each year.
Traditional Medicare does not cover the most basic dental treatments, or prosthodontic procedures such as dental implants. Some Medicare Advantage plans, however, may cover dentistry.
This article will discuss everything you need to know about getting Medicare coverage for dental implants.
Medicare is the United States health insurance program for people aged 65 or older, and those with ESRD (End-Stage Renal Disease) or ALS (Amyotrophic Lateral Sclerosis, otherwise known as Lou Gehrig's disease).
Although it helps with some of the health care costs, it doesn't cover all medical expenses.
Medicare Part A covers inpatient care and services in hospitals, skilled nursing facilities, nursing homes, and hospices.
Medicare Part B covers outpatient services such as doctors’ visits, tests, and consultations. Part B also covers screening and preventative treatments.
Medicare Part C, also known as Medicare Advantage (MA) Plans, covers inpatient hospital care, mental health services, rehabilitation services, and hospice care.
Medicare Part D covers self-administered prescription drug costs. These costs are covered by stand-alone prescription drug plans (PDPs) and most Medicare Advantage plans.
When a permanent tooth falls out or must be extracted due to injury or decay, a dentist typically recommends replacing it.
Dental implants are metal posts or frames that are surgically implanted beneath your gums into your jawbone.
They allow your dentist to mount replacement teeth onto them once they are secured in place.
According to the American Dental Association (ADA), there are two types of implants that they consider safe:
Placed in your jawbone to act as an artificial root for a replacement tooth. It is the most common type of implant.
A metal frame that fits over the jawbone and below the gums. It is made up of a series of posts that are used to support the placement of a dental prosthetic such as a crown, bridge, or denture.
Because no two dental implant procedures are similar, the prices are always given as a range.
Some factors that affect the cost of dental implants are:
The number of implants you need
The materials used in the implants
Sedation dentistry options
Dental insurance and financing
According to the Levin Group, a dental management consultancy, the total cost per tooth, from start to finish, typically ranges between $3,000 and $4,500.
This means that a person who requires a full set of implants can expect to pay between $60,000 and $90,000.
Preparatory treatments are procedures done before you get dental implants.
Some of these include:
The number of extractions and tissue grafts you need will affect the overall cost of your dental implant procedure.
In general, Medicare does not cover dental care or procedures such as cleaning, filling, and extracting, or prosthetics like dentures and dental implants.
If you are set on using Medicare and considering dental implants, it’s worth investigating joining a Medicare Advantage plan.
The majority of Medicare Advantage plans include dental benefits. However, depending on your plan and coverage, you may have to pay a coinsurance or copayment amount.
Copayment: A copayment is a set amount that your health plan requires you to pay out of your own pocket for a specific medical treatment or procedure.
For example, an insurance plan with copayments may require the insured to pay $25 per doctor’s visit or $10 per prescription.
Coinsurance: Coinsurance is the percentage of costs for a covered health care service that you need to pay after you've paid your deductible.
For example, if your health insurance plan's allowed amount for a doctor’s office visit is $100 and your coinsurance is 20%, you pay 20% of $100, which is $20.
If you want to keep your Original Medicare (Plan A or B), you should look into a separate stand-alone dental plan that specifically covers dental implants and other dental treatments.
This will most likely not cover all of your costs, but it may cover enough to make it worth your while.
Dental implants are usually done by prosthodontists or oral surgeons.
Dental implant information is also frequently listed separately in your explanation of benefits. Dental coverage will be under one of these:
To make sure dental implants are covered by dental insurance, thoroughly review your dental coverage for one of the four options listed above.
Prosthodontics: The diagnosis, treatment planning, rehabilitation, and maintenance of oral function. It usually deals with crowns, dentures and bridges.
While Medicare doesn’t generally cover dental implants, there are other expenses related to dental implants that they might cover, such as:
X-rays to determine the state of your gums and teeth roots
If you have a Medicare Advantage plan with dental benefits, then routine exams and x-rays are usually covered.
Tooth extractions may be partially covered as well, depending on your plan. Crowns are sometimes covered, but if a plan excludes dental implants, the crowns associated with them are usually excluded as well.
The majority of dental implant procedures are done on an outpatient basis. Your Medicare Advantage plan may partially or fully cover costs associated with dental implants procedures, such as anesthetics or nitrous oxide.
However, the best way to determine whether your Medicare Advantage plan covers expenses related to dental procedures is to talk directly to your dental provider.
If you have a Medicare Advantage plan that would **pay for dentures as an alternative to implants, you should explore if those benefits could be applied to dental implants.
If you're looking for a provider that will offer you dental, hearing, and vision benefits, reach out to one of our agents today.
Seeing as more and more Americans are making use of dental implants, PolicyScout wants to ensure that every individual gets the best dental implant coverage in the event that it's needed.
If you want up-to-date and accurate information about Medicare, Medicare Advantage, or anything else Medicare-related, visit PolicyScout's Medicare hub to learn more and find the best plan for you.