Is Medicare covered for dental implants?
Original Medicare does not offer dental coverage. Part A (hospital insurance), and Part B (medical Insurance) do not cover it. While most Medicare Advantage plans (MA) offer some dental coverage, not all plans cover dental implants.
Dental implants are part of the prosthodontics branch of dentistry. This includes the creation, manufacturing, and fitting artificial teeth replacements. Dental implants can be used as an alternative to bridgework or dentures. They provide solid support for your teeth and don’t require any adjustments.
A dental implant requires surgery. From start to finish, the entire process can take several months. Three main components are required for dental implants:
- Implantation of a metal post surgically to replace the root of a missing tooth.
- An extension of the post is called an abutment.
- Placing an artificial tooth (crown), on the abutment gives you the appearance and feel of a natural tooth.
The process may involve multiple procedures depending on which type of implant is chosen and how your jawbone is. It can take several months because the bone must heal around the implant.
Implants can be expensive and time-consuming. Your dentist and you will make the big decision about whether to place dental implants. The pros and cons of dentures will be considered, along with the health of your jawbone. The insurance company may cover the cost of dentures. You may find that the cost of dental implants is worth it, even if you have to pay out-of-pocket.
What Medicare plans are most beneficial if you require dental implants?
Medicare Advantage plans that include supplemental dental coverage, such as dental implants, will prove to be very beneficial. There may be an additional monthly fee. You will also have to pay a copay and/or coinsurance. You will have to pay an out-of-pocket cost if you require dental implants.
Some MA plans do not cover dental implants. Even if the MA plan offers comprehensive dental benefits, some plans exclude dental implants.
MA plans include “dental implants” either as a covered item, or an exclusion in their Evidence Of Coverage (EOC). If you have dental implants covered, you’ll be responsible for copays or coinsurance up to the maximum annual benefit. The remaining cost of services received in that year will be your responsibility.
The EOC provides detailed information about dental coverage, but it can be confusing to understand the codes and terminology involved. It is best to speak with a dentist who regularly works with insurance companies, and who understands all the codes and terms associated with prosthodontic treatments.
An EOC review of several of the largest MA plan insurance companies in America shows that there are two major carriers that have benefits for dental implant coverage in 2021. To find out if these plans are available in your area, you will need to search the EOC of each company. Search on the Medicare website to find out if your dentist is a network provider.
- CVS Health/Aetna – Prosthodontics are covered as part of comprehensive dental care benefits. Each year, they can receive a maximum of $1,000 for all services (including prosthodontics). A licensed dentist must be able to accept Medicare patients in the U.S., and not opt out of Original Medicare. All services must be paid for and then a claim form is submitted for reimbursement. You do not have to pay for any dental services you receive.
- BlueCross BlueShield/Anthem – Optional supplemental Package #3 provides enhanced vision and dental benefits. A $66 monthly premium is required. All dental benefits will be covered by the plan up to $2,000 each year. Only DentaQuest providers are allowed to use the plan. You pay 50% of the covered costs for implants until you receive your maximum benefit. You then pay any additional costs. You are not allowed to spend more than your out-of-pocket limit for in-network dental services.
What is Medicare coverage for dental implants?
Other expenses associated with dental implants include exams, xrays to assess the health of your teeth roots and gums, as well as tooth extractions. Routine exams and xrays are usually covered if your MA plan includes dental benefits. Your plan may cover tooth extractions up to a partial extent. Sometimes crowns are covered but not all dental implants are covered. If a plan does not cover them, then the crowns that are associated with them will usually be excluded.
Most dental implant procedures can be performed outpatient. Your MA dental plan may partially cover the costs associated with procedures like anesthetics or nitrous oxide.
Talking to your dentist/biller to find out if your MA policy with dental benefits covers these additional expenses for dental implants is the best way to confirm. They are experts in insurance and will be able to help you determine which codes apply to your claim.
It is worth looking into whether you could get some of the benefits from a MA plan to pay for dentures instead of implants.
Is Medicare covered for medications after or before implant surgery?
You may require medication before or after surgery. Part D, or your MA plan that includes drug coverage, will only cover medications that are listed on the formulary. You will typically have copays or coinsurance costs. These will depend on the tier of medication your dentist prescribes.