Does Medicare Cover Dental Implants
Medicare is the social insurance for Seniors. It helps cover the costs of health care for people who are 65 or older and for some people with disabilities. Unfortunately, Medicare does not cover most routine or other dental services, such as fillings, cleanings, dentures, or implants. Medicare does not cover dental implants or associated dental work. However, it may cover part of the hospital or oral surgery costs if the procedure is medically necessary to treat a covered condition.
Medicare may cover dental care:
- If dental care is needed due to an injury or illness that requires hospitalization. For example, if you break your jaw, Medicare may pay for surgery to reconstruct it.
- If dental care is needed due to oral cancer or another covered illness.
- If a tooth needs to be removed before heart surgery, radiation therapy, or another covered procedure.
Medicare Information
Medicare was created in 1965 and is administered by the Federal Government. Original Medicare covers most, but not all, of the costs of medical services and products. Parts A and B are the basic building blocks of Original Medicare, and they pay for about 80% of your healthcare. Medicare supplement plans that cover 20% can be purchased through private insurance companies. Drug coverage can also be purchased through private insurance companies. Another way to receive Medicare benefits is through Medicare Advantage plans. These combine all parts of Medicare, and you can also enroll in these plans through private insurance companies.
Parts of Medicare
None of the parts cover 100% of health care. Each of them has certain limits and restrictions, as well as a deductible that must be paid when using medical care.
- Part A - Hospital Insurance covers the care a patient receives during a stay in a hospital, specialized care center, or hospice
- Part B - Medical Insurance covers the cost of doctor visits, medical tests, outpatient procedures, emergency room visits, ambulance services, and much more
- Part C - Medicare Advantage “Advantage Plans” combine hospital and medical parts and often include coverage for medicines
- Part D - Drug Insurance helps pay for the costs of medicines picked up at the pharmacy
Major Parts of Medicare Coverage
Most people receive their benefits through Original Medicare. Each part of Medicare is responsible for a specific part of health care. In this option, the payer is the federal government directly from the Medicare system. You can then be treated by any doctor and any hospital that accepts Medicare. Most hospitals and doctors in the country accept Original Medicare.
What doesn't Medicare cover?
- Dentist
- Routine eye and hearing examination
- Glasses, lenses, and hearing aids
- Healthcare outside the United States
- Plastic surgery
- Most chiropractic treatments
- Acupuncture and alternative medicine
Medicare Supplement Plans
A "Medicare Supplement" policy, also known as Medigap, is private health insurance that is designed to complement original Medicare. Medicare Supplement helps pay for the portion of your health care costs that Original Medicare doesn’t cover. These “gaps” include deductibles and copayments. While Original Medicare and Medigap plans don't pay for most dental work, many Medicare Advantage plans do offer some form of dental coverage. Benefits vary, but many plans pay for preventive care like oral exams, cleanings, and X-rays, and some cover a portion of the cost of expensive procedures like crowns, bridges, and root canals.
If you have Original Medicare and a Medigap policy, this means Medicare will pay approved limits for your health care costs and then your Medigap policy will pay its share of coverage.
A Medigap policy is different from an Advantage Plan because the Advantage Plan and Medicare are how you receive your Medicare benefits, while Medigap is just a supplement to Medicare coverage.
Every Medigap policy must adhere to federal and state laws that are designed to protect beneficiaries. The policy must clearly state that it is a Medicare supplement policy. Insurance companies in most states can only sell standardized policies labeled A through N. Each such policy must offer the same set of coverages, no matter which company it is purchased from. The monthly premium is usually the only difference between Medigap policies.
Medicare Advantage Plans (Part C)
People with Part A and B insurance can join Medicare Advantage plans. Medicare Advantage plans are offered by private insurance companies. Each year, these plans must be approved by Medicare and are rated based on the quality of care they provide. A person with one of these plans cannot have Medigap coverage. Medicare Advantage plans can include additional benefits, such as coverage for additional hospital stays after the number of days covered by Original Medicare. Additional benefits can include drug coverage, dental care, or vision screenings. Each Medicare Advantage plan has a set out-of-pocket spending limit after which the plan will cover 100% of the patient's medical costs.
A Medicare Advantage plan is not a Medicare supplement plan. It is an alternative way to receive your Medicare benefits. We can loosely call this plan a “Medicare Advantage Plan” because each plan must include the minimum benefits of Original Medicare plus an additional set of benefits.
Medicare Drug Plans (Part D)
Medicare Prescription Drug Plans (Part D)
Anyone with Medicare Hospital Insurance (Part A), Medicare (Part B), or a Medicare Advantage Plan (Part C) is eligible to join a prescription drug plan (Part D). Joining a Medicare prescription drug plan is optional, and you pay an additional monthly premium for the plan. Some beneficiaries with higher incomes will have to pay higher monthly premiums for Part D coverage.
Paying for your implant without Medicare
If you need a dental implant, it is important to discuss your options with your dentist. Many dental offices provide financing options, such as CareCredit or a payment system. Additionally, If your private health plan or Medicare doesn’t have dental benefits, you can shop for a stand-alone dental plan. Many plans have premiums that range from $25-$30 a month. Make sure the dental plan will cover implants, which not all plans will.
In conclusion
In general, while Medicare covers most of your healthcare needs, it generally will not cover the cost of dental implants, which can be upwards of $2,000 or more per implant. If you need this procedure, reach out to us today and will can discuss your options for affording your implants.
