Dental coverage under Medicare may be a common topic of confusion for you, like many people. More specifically, you may be questioning whether Medicare covers dental implants or not. Like most dental services, dental implants are not typically covered by Medicare. Let’s take a closer look at dental implants and how Medicare covers dental services.
What are dental implants?
A dental implant is a prosthetic replacement for a tooth root. The procedure usually replaces a tooth root with a metal post like a screw. These screws are typically made of titanium because of the element’s durability and ability to fuse with your jawbone.
You need a dental implant because of tooth decay, tooth loss, or injury. Dental implants may be another option if you don’t want to wear dentures.
Does Medicare cover dental implants?
In most cases Medicare will not cover dental implants. Let’s look at the different parts of Medicare and how they relate to dental implants and dental coverage as a whole.
Part A and Part B
Medicare Part A and Part B do not cover routine dental services, including dental implants. Part A may cover dental services if you are admitted to the hospital and need emergency surgery, or a complicated dental procedure done as in inpatient. However, in most cases, Part A and Part B will not cover dental services.
If Medicare Part A and Part B won’t cover a medical service, neither will a Medigap plan. Your medical service provider will bill Medicare for your service or procedure first. Medicare pays their approved portion of the service or procedure and sends the remaining amount to your Medigap plan.
If Medicare does not cover a service, then they won’t pay, which means your Medigap plan won’t pay either. Since Medicare usually doesn’t cover dental implants, a Medigap plan will not provide coverage.
Medicare Advantage Plan
Some Medicare Advantage plans may offer additional dental, vision, and hearing benefits, but each plan is different. To know for sure, you’ll want to check the plan’s Summary of Benefits. However, do keep in mind that Advantage plans can change their benefits from year to year. So, it’s not recommended you choose an Advantage plan based on its additional benefits.
What dental services does Medicare cover?
If Medicare does cover a dental service, it’s usually because the procedure is related to another disease or condition when it’s medically necessary. For example, Medicare will cover an oral examination preceding a kidney transplant or heart valve replacement in certain situations. Medicare will also cover jaw reconstruction due to accidental injury and tooth extractions before cancer treatment.
The oral examination will be covered by Part A if it’s done by a dentist working for the hospital and you are an inpatient. Part B will cover the examination if it’s done by a physician in an outpatient setting.
There are a few other specific situations in which Medicare would provide coverage, but Medicare will not pay for dental services in most cases.
What options are there for dental care?
If Medicare doesn’t cover dental implants and other dental services, what options are there for coverage? As mentioned before, some Medicare Advantage plans can offer additional benefits, including dental, hearing, and vision benefits. If you’re looking for an Advantage plan that provides these benefits, you should make sure the plans you’re considering cover the dental services you need. However, remember that Advantage plans can change their benefits every year. One year you may have dental coverage, and the following year you might not.
What if you don’t want to enroll in an Advantage plan? Many Medicare beneficiaries will enroll in a standalone dental insurance plan to make sure their needs are met. Enrolling in a standalone dental plan is separate from the Medicare system. This means your dental plan won’t coordinate with your Medicare plans, but it can still provide coverage and help you save money.
Medicare will not cover routine dental services, including dental implants. Medicare will only cover specific dental services and procedures related to other conditions or require hospitalization. Most beneficiaries will enroll in an Advantage plan that offers these benefits or a standalone dental plan.