Does Medicare Cover Dental Implants
In short, dental care, including dental implants, is not covered by Medicare plans. While dental implants and other dental treatments are not directly covered by Medicare, some of the associated costs related to getting dental implants are. Patients have many options available to them so this article will examine them one by one.
Dental Implant Overview
Implanted directly into the gums, dental implants are an ideal solution for replacing one ore more lost teeth. Unlike removable dentures that rest on the wearer’s gums and are prone to shifting out of place, dental implants offer a more secure restoration that look, feel, and function more like natural teeth. In addition to being more securely held in place, dental implants offer numerous benefits.
However, the process for getting dental implants is much more complex than with dentures and the procedure can take several months to complete. Often, multiple types of procedures, diagnoses, and prescription drugs are employed. While Medicare will not directly cover the cost of dental implants, some of the related costs may be provided for.
Process to Get a Dental Implant
The process involved with getting a dental implant takes place over several different stages that will be billed for as separate individual procedures. The process begins with an initial consultation or evaluation. During this examination, the doctor will determine the scope of work needed, recommend the ideal solution to address the patient’s needs, and discuss price.
Once the treatment plan has been developed, the doctor will surgically place the implant, abutment, and replacement crown. After surgery, time is needed to allow the wound to heal and the biological fusion process to occur between the implant and jawbone. Depending on how quickly the patient heals, this could take several months but one the permanent crown has been placed, the dental implant is finished.
Dental Implant Alternatives
Whether due to cost, not being a candidate for the procedure, or simply not wanting to undergo surgery, there are alternatives to dental implants. Resin-bonded bridges, fixed-tooth bridges, and removable partial dentures are some alternatives for patients that do not opt for getting a full implant.
While these other treatments are typically less expensive than dental implants, they will still not be covered by Medicare, but some may be partially, or fully, covered by Medicare Advantage.
What is the Cost for Dental Implants?
Like most medical or dental procedures, the cost involved with dental implants can differ significantly. Factors that influence cost include the geographic location where surgery is performed, the doctor performing the procedure, the equipment used for the procedure, the number of implants placed, and any other health conditions that must be addressed as part of the process.
Dental implants are comprised of two components with widely varying cost. The metal implant itself, likely will cost in the range of $1,000 to $3,000. Implants also require abutments or crowns, which can add an additional $500 to $3,000 to the overall cost. Clearly this is a wide range of prices but in general, the overall price for an implant from start to finish will seldomly be under $3,000 and could end up being significantly higher. Should a full set of dental implants be needed to replace an entire upper or lower jaw, cost could reach $30,000 or more.
Medicare Part A: Getting a Dental Implant at a Hospital?
Care delivered in hospital settings is covered by Medicare Part A. While rare to have dental implants placed in a hospital, some aspects of the procedure may take place in a hospital. In certain circumstances, the implant surgery may need to be done in a hospital. While not applicable for a dental implant procedure, Medicare Part A does cover some dental care and checkups, notably prior to heart valve replacement or a kidney transplant.
Even if a portion of the diagnosis or procedure takes place in a hospital, it does not automatically mean Medicare will cover the cost. For example, Medicare may cover hospital admittance but not the actual cost of dental care received there. If possible, patients should try to verify this with the hospital ahead of time.
Part D: Covering Prescription Drugs for Dental Implants
Prescription drugs are covered under Medicare Part D and unlike Original Medicare, private insurance companies provide Part D that must be purchased separate from the rest of Medicare. It may also have coverage area restrictions or other limitations that Original Medicare does not.
Often, prescription pain relievers will be given following dental implant surgery. Other prescription medications or antibiotics could also be needed depending on the patient’s specific situation or condition. In all likelihood, Medicare Part D will cover the cost of these medications but again, patients are encouraged to verify coverage with their provider prior to surgery.
Can Medigap Plans be Used to Cover Dental Implant Costs?
Medicare Supplement Plans, also called Medigap plans, are privately provided insurance plans that help with fees, like coinsurance payments and deductibles, that Medicare usually does not cover. Although Medigap plans will not directly cover the cost of most medical care, including dental implants, should any portion of the implant procedure occur in a hospital, Medigap can help with the Part A deductible.
Does Medicare Advantage Cover Dental Implants?
Also called Medicare Part C, Medicare Advantage is a method of getting Medicare benefits through private insurance carriers. Plans of this type must have coverage at least equal to Part A and Part B but could also cover additional items. For example, dental and vision care are commonly covered by Medicare Advantage neither of which are provided for by Original Medicare.
Since they are private, Medicare Advantage plans are subject to many of the limitations associated with other private plans the patient may already be used to. Plans of this type are either PPO or HMO plans and the overall coverage area will have limitations that Original Medicare lacks. Often patients are happy to make this trade-off since Medicare Advantage plans provide additional coverage.
While it cannot be determined ahead of time if Medicare Advantage will cover dental implants, some plans to and could also include routine dental care. Because using Medicare Advantage can be complex in comparison to Original Medicare, patients should carefully weigh their options prior to making a final decision.