Will Medicare pay for dental implants?

For the most part, understanding what your health insurance covers vs. what requires dental coverage is pretty straightforward. Health insurance covers preventative care, illnesses, injuries, and other doctor visits. If you need the dentist, it’s typically covered by your dental.

Things get a little less clear when Medicare is involved. Seniors who depend on Medicare for their healthcare may find themselves in need of dental implants. Dental implants require surgery, but knowing where to go can be confusing since they involve your teeth.

It’s very challenging to find a dentist or oral surgeon that accepts Medicare because, as a general rule, Medicare does not cover any dental procedures. However, there are ways for seniors to get dental implants paid for by Medicare.

So, does Medicare cover dental implants? Medicare Advantage plans can provide you with the coverage you need for dental implants. Enter your ZIP code into our free tool to see what quotes might look like for you.

Does Medicare cover dental implants?

Millions of Americans rely on Medicare for their healthcare, and most wonder if dental services are included at one point or another. Unfortunately, Original Medicare does not cover dental implants.

Medicare covers injuries and illnesses, as well as preventative healthcare services – in short, medically-necessary healthcare services. As long as you and your doctor can prove that something is necessary for your health, Medicare will usually cover it.

In this manner, some people get dental work covered by their Medicare insurance. However, convincing Medicare that your dental implants are a necessary service is next to impossible. Medicare might pay for some related dental care, though. For example, if you have a health condition that requires the removal of a rotten tooth before your doctor can treat you, Medicare will probably cover it.

This applies to Original Medicare. If you need dental coverage and you’re eligible for Medicare, you should consider a Medicare Advantage plan.

Does Medicare Advantage cover dental implants?

Wondering what insurance covers dental implants? You have two choices – traditional dental or Medicare Advantage.

Medicare is split into four parts. Original Medicare, which does not cover dental work, is made of Part A and Part B.

Part A is sometimes called hospital insurance because it covers inpatient treatment. Hospital stays, some nursing facility services, and home care are all covered by Part A.

Part B is outpatient coverage, which includes preventative healthcare, doctor visits, and medical equipment like walkers or wheelchairs.

Additional coverage you can buy is Part D, which covers prescription medication.

Medicare Advantage, also known as Part C, combines Parts A, B, and usually D into one convenient plan. It also offers supplemental insurance to cover the gaps in Original Medicare. You can usually add dental insurance to your plan, as well as vision, hearing aid coverage, and many other benefits.

While Medicare Advantage plans vary by the company you buy from, they are required by law to be at least as good as Original Medicare. That means if you buy a Medicare Advantage plan, you’re guaranteed at least as much coverage as Parts A and B afford.

Of course, dental coverage through a Medicare Advantage plan will work similarly to most other dental plans. It probably won’t pay for the entire dental implant procedure. Instead, most Medicare dental plans cover around 50% of the total cost.

If you want to know how to get Medicare to pay for dental implants, a Medicare Advantage plan is the way to get it.

Does Medicare cover prescription medication after dental implants?

Having spikes drilled into your jawbone or damaged teeth removed will leave you with more than a headache. You’ll probably need antibiotics to make sure no infections grow in your mouth.

Original Medicare will cover medication from any hospital visits. Other than that, Original Medicare doesn’t cover medication for dental services.

Medicare Part D is a prescription drug plan that covers medicine a doctor prescribes to you for most reasons. Most Medicare Advantage plans will cover your medicine as well.

Parts C and D generally cover pain medication, antibiotics, and other prescriptions. If you’re concerned about the price of medication you might need, you can check with your plan before you get your implants to make sure you’re covered.

Read more: Will dental insurance pay for antibiotics?

What are dental implants?

Most people take their teeth for granted until something goes wrong. As one of the most delicate areas of your body, your mouth requires a lot of work to keep healthy.

From tooth decay to injury, there are many reasons why you might need to replace a tooth. Dental implants are an alternative to dentures or bridgework. Although they can replace multiple teeth, dental implants are easiest when you’re only missing one or two.

To install a dental implant, your dentist will remove the damaged tooth or teeth. Then, they implant a metal screw or post into your jawbone. That post is what will securely hold your new tooth in place.

Getting a dental implant is a long process because your mouth needs time to heal. When you have a tooth pulled, your gums need four to six weeks to recover enough that a dental implant is possible. Your jawbone also needs time to heal after getting a metal rod driven into it. Once your jaw is completely healed, your dentist will attach your tooth, and you’re done.

Does Medicare cover other dental work?

In addition to dental implants, Medicare usually doesn’t cover any other dental services, including:

• Cleanings
• Fillings
• Tooth extractions
• Dentures
• Dental plates

However, Medicare Part A will cover dental services you receive in a hospital, especially if they are necessary for other health procedures.

If you are injured, such as in a car accident, Medicare will most likely pay for oral surgery to fix your mouth. You might even qualify for plastic surgery if an injury interferes with your quality of life.

Unless you and your doctor can prove that your dental work is medically necessary, Original Medicare won’t cover it. However, a Medicare Advantage plan can give you the dental coverage you need.

Case Studies: Dental Implants and Medicare Coverage

Case Study 1: John’s Medicare Advantage Coverage

John, a Medicare beneficiary, needed dental implants to replace several missing teeth. Knowing that Original Medicare does not cover dental services, he explored his options and enrolled in a Medicare Advantage plan.

His Medicare Advantage plan provided comprehensive coverage, including dental benefits. With his plan, John’s dental implants were covered, reducing the financial burden of the procedure.

Case Study 2: Mary’s Out-of-Pocket Expenses

Mary, another Medicare recipient, opted to proceed with dental implants without supplemental coverage. She understood that Original Medicare does not cover dental implants and decided to pay out-of-pocket for the procedure.

Although she had to bear the full cost of the dental implants, Mary believed it was a necessary investment in her oral health and quality of life.

Case Study 3: David’s Medicare Advantage Savings

David, who required dental implants, initially assumed that Medicare would not cover the procedure. However, he discovered that Medicare Advantage plans often include dental coverage. David compared various Medicare Advantage plans and found one that offered dental benefits, including coverage for dental implants.

By enrolling in this plan, David significantly reduced his out-of-pocket expenses for dental implant surgery.

Case Study 4: Sarah’s Partial Coverage

Sarah, a Medicare beneficiary, underwent dental implant surgery to replace a single missing tooth. She had a Medicare Advantage plan that covered dental services but found out that the plan only provided partial coverage for dental implants. While the plan covered a portion of the costs, Sarah still had to contribute a significant amount toward the procedure.

Case Study 5: Robert’s Ineligible Situation

Robert sought Medicare coverage for dental implants but faced disappointment when he realized that Medicare does not consider dental implants medically necessary. As a result, Robert had to explore alternative financing options or consider supplemental dental insurance outside of Medicare.

Find the Best Medicare Advantage Plans for You

Dental implants are important for your health if you have damaged or missing teeth. Having all of your teeth makes life easier, and missing teeth can change the shape of your mouth. Plus, it’s nice to have a smile you’re comfortable sharing.

Now that you can answer, “Does Medicare cover dental implants?” you probably have a better idea of whether or not you need a Medicare Advantage plan. If you want to see what rates might look like for you, enter your ZIP code into our free tool today.