Does Medicare Cover Dental Implants?
When a patient is missing one or more of their teeth, dental implants offer an excellent long-term tooth replacement solution. It is common, especially as we age, to lose teeth or experience significant decay. Based on data from the American Dental Association (ADA), about half of all US adults who are older than 65 are missing one or more teeth. A common question older patients have is whether Medicare covers the cost for dental implants. The unfortunate and direct answer to this question is no, Medicare does not cover the cost of this treatment. Medicare plans do not include coverage for dental care, including dental implants. While Medicare does not provide coverage for the cost for implants and dental procedures, it can provide some coverage for additional costs associated with the procedure. This article will summarize options and typical coverage as it relates to Medicare and dental implants.
Modern dentistry introduced dental implants as an excellent solution for replacing missing teeth. The procedure for placing an implant involves a screw-like post which is placed directly into the jawbone. In most cases, the implant is made from titanium material. As the body heals, the implant will naturally fuse to the jawbone. Once this process is complete, a prosthetic tooth or crown is attached to the implant. This allows the implant to have similar appearance and function of a natural tooth. When they are properly cared for and the patient maintains good oral hygiene, dental implants are extremely secure and can last for many years.
When comparing implants to traditional dentures, the procedure is relatively complex as it includes a surgical aspect. The timeline will vary, however, the complete process an implant typically takes a couple months, but can be up to a year or more. There may be numerous procedures, various appointments, and prescriptions involved in the process. Medicare does not provide coverage for the cost of implants directly, but it can provide coverage for some of the additional costs.
Cost for Dental Implants
Similar to other dental and medical procedures, the cost for dental implants can vary based on a variety of components. The cost can depend on factors such as the geographical region, additional health conditions like diabetes, the type of implant being used, where the implant is located, and number of implants being used. Another major component which can impact the cost is the dentist selected for the procedure. This can also directly impact if the procedure has a successful outcome.
There are three main components of a dental implants including the implant post, the abutment, and the crown. The surgical placement and the implant post usually cost about $1,000 to $3,000. The abutment and crown cost about $500 to $3,000. On average, the implant procedure costs about $1,500 to $3,000 or more per tooth. In cases where a complete set of implants are required, the cost will be close to $30,000.
There are a few steps included in the dental implant procedure. With the first step of the process, or the consultation, the dentist will complete a thorough evaluation. This includes an evaluation of the patient’s oral health, medical history, list of medications, questions, estimated cost, and expected outcome. With the next phase of the process, the implant is surgically placed. Lastly, the abutment is attached and the permanent crown is placed.
Alternative Solutions
Due to the high costs associated with the implant procedure, patients sometimes opt to seek alternate solutions. In other cases, the patient may not qualify as a candidate for implants due to inadequate bone which is necessary to support the implant. There may also be other health factors or issues which disqualify the patient from being a candidate for implants. Fortunately, there are other tooth replacement options such as removable partial dentures, fixed-tooth bridges, and resin-bonded bridges. While these solutions may cost compared to implants, they are also not covered by Medicare. In some cases, Medicare Advantage plans may cover some or all of the cost of some of these alternate options.
Medicare Part A
Medicare Part A is used to cover the cost associated with any required hospital care. While it is quite rare for a dental implant procedure to be completed in a hospital setting, there may be some portions of the procedure which are completed in the hospital. In some cases, there are unique circumstances which make it necessary for the procedure to be completed in a hospital. Medicare Part A also covers some types of dental checkups and routine care. As an example, it can be used to cover dental procedure costs which are completed prior to a kidney transplant or heart valve replacement. With implants, however, these circumstances typically do not apply.
It is important to clarify that when certain portions of the implant procedure are performed in a hospital, this does not mean that Medicare will cover the entire cost. In most cases, Medicare pays for admission to the hospital, but does not cover the dental care specifically. It is important for the patient to discuss expected costs, coverages and logistics with the dentist prior to beginning the procedure.
Medicare Part D and Prescription Drug Coverage
Medicare Part D gives the patient coverage for prescription drugs. Contrary to Medicare, patients obtain Part D through a private insurance company. This coverage is purchased separately from traditional Medicare. With the dental implant procedure, it is common for the dentist to write a prescription for a pain relief medication. Medicare Part D plans almost always cover the cost for these types of medications.
Medigap Plans
Medigap plans, or Medicare Supplement Plans, are private insurance plans patients can use to aid in covering things that are not covered by Medicare such as coinsurance payments and deductibles. Medigap plans do not directly cover most types of medical care. In addition, they also do not cover the cost associated with dental implants. If any portion of the dental implant procedure is performed in a hospital, however, the Medigap plan may be used to cover the Medicare Part A deductible.
Medicare Advantage
Medicare Advantage, also known as Medicare Part C, provides patients with Medicare benefits through a private insurance company. A Medicare Advantage plan is required to provide coverage equivalent to Medicare Part A and Part B. Patients often use an Advantage plan to obtain additional coverage. For example, Medicare Advantage plans often include coverage for vision and dental, which are not included in traditional Medicare plans.
Unfortunately, there is no easy way to identify if Medicare Advantage will aid in providing coverage for the cost of implants. While the procedure is covered in some instances, it is not a guarantee. The plan often covers the cost for routine dental care, which can help cover specific portions of the procedure. Medicare Advantage is slightly more complicated than Original Medicare. Patients should review their coverage and expected costs prior to beginning the implant procedure.