Does Medicare Cover Dental Implants
Many adult patients have damaged or missing teeth. Dental implants are an excellent tooth replacement solution. Patients who are on Medicare often want to know if Medicare covers the cost associated with dental implants. Below is a summary of the dental implant procedure and an explanation of dental benefits associated with Medicare coverage.
Dental Implants
A dental implant is an artificial tooth or crown which is connected to the metal implant post. The implant itself is a screw-like device which is surgically placed into the jawbone. The implant works by replacing the roots of the missing tooth. There are various applications for dental implants. They can be used to replace an individual missing tooth, multiple missing teeth, and as the foundation for dentures.
Implant Procedure
Prior to beginning the implant procedure, the dentist will schedule a consultation with the patient. During the consultation, the dentist or oral surgeon will evaluate the patient’s oral health, review their medical history, identify any medications the patient is taking, and discuss any questions related to the procedure.
There are numerous steps involved in placing dental implants. In most cases, the procedure is performed as an outpatient basis. In order for the jaw and mouth to completely heal, it may take several months. If needed, the dentist will first remove damaged or decayed teeth. The patient may also require additional procedures such as bone grafting if they lack adequate bone structure required to support the implant.
A high level summary of the procedure is outlined below:
- Evaluate the jawbone to ensure it can accommodate the implant. Complete bone grafting as needed
- Surgically place the implant into the jawbone and allow it to heal
- Attaching the abutment and connecting the artificial tooth to the implanted post. This gives the implant the function and appearance of natural teeth
One major benefit of dental implants is that they stimulate the jawbone and prevent bone loss. When patients are missing teeth or even when patients have dentures, bone resorption is common as the jawbone fails to be stimulated. This can result in a change in the shape of the patient’s jaw and even in their facial appearance.
Dental implants are considered to be the best treatment option for patients who are missing one or more teeth. Missing teeth in adults is commonly due to periodontal disease, decay, an accident, or injury. Implants can support an individual replacement tooth or can be strategically placed to support a bridge which replaces multiple teeth or an entire arch.
Dental Implant Cost
The cost for dental implants can drastically vary based on different factors such as the geographical region, type of implant, number of implants, the location of the missing tooth, the patient’s oral health, and if the patient has other complications or medical issues.
A dental implant contains two components. This includes the implant and the abutment or crown. The implant and surgical procedure for placement cost an average of $1,000 to $3,000. The abutment or crown costs an additional $500 to $3,000. The entire implant procedure costs an average of $1,500 to $3,000. In some cases, the procedure may cost more if there are additional procedures or complications. If the patient is missing all their teeth in the top or bottom jaw and requires a complete set of implants, the cost will be closer to $30,000. Because there are numerous variables associated with an implant, patients must work directly with the dental office to determine the expected cost for treatment.
Dental issues naturally become more common as patients age. As patients get older, they are at an increased risk for tooth decay, damage from normal wear and tear, and tooth loss in general. The loss of teeth can negatively impact the patient’s confidence and quality of life. While dental implants are an exceptional treatment option, they are also quite expensive. Medicare recipients are often curious regarding the cost for the procedure and how Medicare benefits apply to dental implants.
Below is a summary of how Medicare applies to dental implants. Patients should work directly with the dental office to determine the cost and how their Medicare benefits apply to the procedure.
Medicare Part A
Medicare Part A applies to care provided in the hospital. While the dental implant procedure is not typically completed in a hospital setting, certain parts of the procedure may be performed in a hospital. In special circumstances, the procedure may need to be completed in a hospital. Medicare Part A may also cover some dental care and checkups; however, this is not common. These things are covered when they take place prior to a kidney transplant or heart surgery. In general, Medicare Part A does not apply benefits to the dental implant procedure.
Part D
Part D provides patients with coverage for prescription drugs. Unlike Medicare, Part D is offered by private insurance companies and must be purchased separately from Medicare. This type of coverage may also be subject to specific coverage areas and have other specific limitations.
Patients who receive one or more dental implants may receive a prescription for pain relief medication to be used following the procedure. In most cases, private Medicare Part D plans will cover these types of medications. Patients should always review their coverage and expected costs prior to beginning the procedure.
Medigap Plans and Dental Implants
Medigap plans or Medicare Supplement Plans are private insurance plans that help cover additional costs which Medicare does not cover. These plans may include deductibles and coinsurance payments. Medigap plans will not usually cover the costs associated with dental implants. If any portion of the dental implant procedure is performed in a hospital setting, the Medigap plan may help cover the deductible associated with Part A.
Medicare Advantage or Part C
Medicare Advantage or Medicare Part C provides patients with additional benefits offered through private insurance providers. A Medicare Advantage plan is required to provide patients with equivalent coverage to Part A and Part B. Many of the Advantage plans offer additional coverage. It is common for Medicare Advantage plans to provide benefit coverage for vision and dental care. These things are not covered by Original Medicare.
Because Medicare Advantage plans are private insurance plans, they have many of the limitations associated with other private insurance plans. Plans are typically considered to be either HMO or PPO plans. Unlike Original Medicare, there is not an unlimited coverage area. Many patients are willing to make this compromise due to the additional coverages offered by Medicare Advantage plans.
Unfortunately, there is no easy way to determine if a Medicare Advantage plan provides coverage for dental implants. Each plan is different, and the patient must work with the provider to determine their specific coverage. In many cases, these plans cover the cost for routine dental care and may provide coverage for portions of the dental implant procedure. Medicare Advantage plans and Original Medicare can be complicated and difficult to understand. It is the patient’s responsibility to understand their coverage and how it will apply to procedures such as dental implants.
In summary, Original Medicare (Part A & B) does not typically cover the cost for dental implants. Patients with Medicare who are interested in dental implants should work with the dental office to determine the cost for the procedure. Patients may have supplemental insurance coverage or Medicare Advantage plans which may provide coverage for the procedure.