Does Medicare Cover Dental Implants

The short answer is no. In general, dental care, including dental implants, is not covered by any Medicare plans. While Medicare will not directly cover most dental procedures or implants, they will cover some of the various other costs associated with the treatment. Patients have several options available so this article will evaluate them individually.

What is a Dental Implant?

Dental implants are used to replace one or more missing teeth. An alternative to traditional dentures that simply rest on the wearer’s gums, dental implants are surgically implanted into the jawbone to replace missing tooth roots. Over several months, the small metal implant posts fuse with the jawbone to create a strong, sturdy foundation upon which a restorative crown or prosthetic tooth can be mounted.

Compared to other restoration treatments, dental implants look and function more similarly to natural teeth making them a desirable choice for many seniors. However, because the complexity of dental implants is greater than dentures, the time involved getting them implanted is longer. Obtaining dental implants may require multiple appointments, diagnoses, procedures, and prescription drugs during the process. While Medicare will not directly cover the dental implant costs, some of these related costs may be covered.

What Do Dental Implants Cost?

Like most medical or dental procedures, dental implants can widely vary in cost. Cost will be influenced by the number of implants placed, the type of implant system used, the materials and equipment used, and any underlying health conditions that require treatment in conjunction with placing the dental implants. The geographic location and experience of the doctor performing the implant surgery can also influence cost as more experienced practitioners or those in larger urban areas, likely charge a higher rate for their services than their less experienced counterparts in smaller cities.

Dental implants are comprised of two main components, the implant and the abutment or crown, and their costs can vary. On average, the implant itself will cost between $1,000 to $3,000 while the abutment or crown can add another $500 to $3,000 to the overall price tag. Clearly, the price range is rather large but generally, patients should expect to pay a minimum of $3,000 from start to finish for their dental implants. But if a full set of teeth need to be replaced or significant other procedures are needed along with implant treatment, cost could push $30,000.

Steps for Getting Dental Implants

The process for getting dental implants takes place over several stages each of which is billed as a distinct procedure. The process begins with an initial consultation or evaluation to determine the best course of action. In subsequent visits, the doctor will place the implant, followed by the abutment, and finally the replacement crown. Placing the crown is the final step and signifies the dental implant is complete.

Medicare Part A: Covering Dental Implants in a Hospital?

Medicare Part A provides coverage for costs incurred while in a hospital setting. Typically, dental implant procedures are not performed in a hospital setting but other aspects of care may occur there. In some instances, the operation may need to be performed in a hospital.
However, getting part of the diagnosis or procedure done in a hospital does not necessarily mean it will be paid for by Medicare. Typically, dental care and dental checkups are partially covered by Medicare Part A, but dental implant procedures are not. If hospitalization is needed, Medicare may pay for the admittance but not cover any dental care that is received there. As such, patients should try to verify this beforehand with the hospital.

Medicare Part D: Covering Prescription Drugs for Dental Implants?

Prescription drug coverage is provided by Medicare Part D. Part D, unlike Original Medicare, is provided by private insurance carriers and must be purchased separately. Part D may also have coverage areas and other limits that Original Medicare does not.

Because surgery is involved, prescription pain medications will be given following a dental implant procedure. Other medications or antibiotics may also be required based on the patient’s specific situation or condition. Virtually all private Medicare Part D plans will cover the necessary prescription medications, but patients should check their coverage prior to treatment.

Can Medigap Plans Help Cover Dental Implant Costs?

Medicare Supplement Plans, or Medigap, are private insurance plans that provide coverage for fees, like coinsurance and deductibles, that Medicare does not. However, Medigap plans do not cover medical care costs directly and as such, will not help with dental implant procedures. Should any portion of the implant procedure occur in a hospital, Medigap can be used to help cover Part A deductibles.

Does Medicare Advantage Cover Dental Implant Costs?

Medicare Advantage, or Medicare Part C, allows patients to get Medicare benefits through a private insurance carrier. While Medicare Advantage plans may provide additional coverage, they must grant coverage that is at least equal to that provided by Part A and Part B. Unlike Original Medicare that never provides for them, vision and dental care are commonly covered by Medicare Advantage plans.
Since they are private insurance plans, Medicare Advantage plans are subject to many of the same limitations that other private plans are. These plans are either PPO or HMO plans and unlike Original Medicare, the overall coverage is not unlimited. Many people are happy with this trade-off because of the additional coverage offered by Medicare Advantage plans.

Unfortunately, there is no way to know if dental implants are covered by a Medicare Advantage plan in advance. The entire procedure may not be covered but some plans provide coverage for the surgery and many cover routine dental care associated with the implant procedure. Medicare Advantage is somewhat more complex to use than Original Medicare so patients should carefully weigh their options before making a final decision.

Private Health Insurance

As noted, Medicare coverage is limited for dental implant procedures. Even if a patient is covered under a Medicare Advantage plan, the other qualities of these plans could make them undesirable. Private dental insurance is a final option worth considering and many plans cover dental implants.

Minimum Age on Dental Implants