Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Does Medicare cover dental implants?
Original Medicare, that is Part A (hospital insurance) and Part B (medical insurance) does not provide for dental coverage at all. Most Medicare Advantage (MA) plans, which are an alternative to Original Medicare, offer some amount of dental coverage for many dental needs, but not all plans help pay for dental implants.
Dental implants fall under a branch of dentistry called prosthodontics, which includes the design, manufacture, and fitting of artificial replacements for teeth. Dental implants are an alternative to dentures or bridgework, providing solid support for your teeth – and you don’t have to worry about ill-fitting dentures.
Getting a dental implant involves surgery. The whole process can take months from start to finish. There are three main components of dental implants:
- Surgical placement of a metal post, usually made of titanium, which replaces the root portion of a missing tooth.
- Installation of an extension of the post called an abutment.
- Placement of an artificial tooth (crown) on the abutment, giving you the look and feel of a real tooth.
Depending on the type of implant you get and the condition of your jawbone, the process can involve several procedures. Part of the reason it can take months is because the bone has to heal around the implant.
Dental implants can be an extensive and expensive process. Choosing dental implants is a big decision that is made between you and your dental provider. You will take into account the health of your jawbone, and the process involved, as well as the pros and cons of dentures. Another important piece of the puzzle is whether or not your insurance will help pay. Even though you will incur out-of-pocket costs, the functionality and look of dental implants may make it worth it to you.
Which Medicare plans will be most helpful if you need dental implants?
Medicare Advantage (MA) plans with supplemental dental coverage that includes dental implants will be most helpful. You may have to pay an additional monthly premium, and there will always be a maximum dental benefit amount allowed, along with either a copay or coinsurance. If you need dental implants, you will incur some amount of out-of-pocket expense.
Not all MA plans cover dental implants. Some MA plans specifically exclude dental implants, even if they offer other comprehensive dental benefits.
MA plans list “dental implants” as either a covered item or an exclusion in the Evidence of Coverage (EOC) document associated with each plan. If dental implants are covered, you will be responsible for a copay or coinsurance until the max annual benefit is reached. You will then be responsible for the remaining costs of the services you receive that year.
Dental coverage is detailed in the EOC, but the terminology, codes, and lists of dental procedures can be overwhelming. It is best to talk with a dental provider who routinely works with insurance companies and understands all the terms and codes associated with prosthodontic procedures.
A review of the EOC of some of the larger MA plan insurance companies in the U.S. shows that two major carriers have some benefits for dental implants in 2021. You would have to check to see if these companies have plans available to you in your area. You can search the Medicare website or contact your dental provider to ask if they are a network provider for these companies:
- CVS Health/Aetna (HMO) – Covers prosthodontics as part of their comprehensive dental care benefit, up to a maximum allowance of $1,000 for all comprehensive services (including prosthodontics) each year. You must see a licensed dental provider who accepts Medicare patients in the U.S. and has not opted out of Original Medicare. You must pay for all services then submit a claim form for reimbursement. Any dental services expenses you incur do not apply to your in-network out-of-pocket maximum.
- BlueCross BlueShield/Anthem (HMO) – Optional supplemental package #3 includes enhanced dental and vision benefits. You pay a $66 monthly premium. The plan will pay up to $2,000 for all dental benefits each year. You must use DentaQuest providers only. For implants, you pay 50% as your portion of the covered charges until your maximum benefit is reached. Then you pay for any other costs. Any dental services expenses you incur do NOT apply to your in-network out-of-pocket maximum.
What does Medicare cover related to dental implants?
There are other expenses related to dental implants, such as exams, x-rays to determine the state of your gums and teeth roots, and tooth extractions. If your MA plan has dental benefits, routine exams and x-rays are generally covered at least in part. Depending on your plan, tooth extractions may be partially covered as well. Crowns are sometimes covered, but if a plan excludes dental implants, the crowns associated with them are typically excluded as well.
The majority of dental implant procedures are done on an outpatient basis. Costs associated with the procedures such as anesthetic or nitrous oxide may be partially covered by your MA dental plan.
The best way to determine if your MA plan with dental benefits pays for these other expenses related to dental implants is to talk directly to your dental provider/biller who works with insurance and understands which codes to apply to your claim.
If you have a MA plan that would pay for dentures as an alternative to implants, it is worth exploring whether or not some of those benefits could be applied to your dental implant costs.
Does Medicare cover medications before or after implant surgery?
Medications you may need before or after implant surgery, such as antibiotics and pain meds, are covered by the drug benefit associated with your MA plan; or by Medicare drug coverage Part D, if you have that instead of a MA plan. Part D or your MA plan with drug coverage will only pay for medications that are on the plan’s formulary. Typically, you will have copay or coinsurance costs, which will vary depending on which tier of drug your dentist prescribes for you.
Learn More From Our Sources
- Medicare | Find a Medicare Plan | Last accessed July 2021
- Mayo Clinic | Information about Dental Implants | Last accessed July 2021
- CVS Health/Aetna (HMO) | Dental Benefits EOC | Last accessed July 2021
- BCBS/Anthem (HMO) | Optional Supplemental Dental Benefits EOC | Last accessed July 2021