It is a common saying if the eyes are the gateway to the soul, the mouth is the gateway to overall health. Thus, dental care is vital for a healthy body but receiving dental services is an expensive affair. To reduce the dental care costs people try to obtain coverage for some common dental services, but there are a lot of complexities in getting major dental services covered. Dental insurance plans across all the spectrum, Medicare, stand-alone dental plans, or ACA-compliant dental plans have complex rules to get major dental care covered. Damaged or missing teeth is a common problem among seniors, who are generally covered under the Medicare plan. Thus, all Medicare beneficiaries have a common question in mind that does their Medicare plan covers dental implants or not?
What are Dental Implants?
A dental implant is a procedure carried out to replace lost natural teeth. Though an expensive alternative to dentures, it is a popular and permanent way to replace lost teeth. In this procedure, artificial teeth are anchored to the jawbone with the help of a metal screw in place of a failed natural tooth. Then a screw is inserted in the place of a tooth’s root and once the screw gets acclimated to the jaw then it is capped with a crown. With time the metal screw fuses with the jawbone and strengthens the overall oral health. It is the best alternative to dentures and help in repairing broken or missing teeth where bridgework is not possible. Dental implants preserve the natural bone and help to restore the growth of the bone. This dental procedure has helped millions of people in the United States.
Dental Coverage under Medicare Plan
The dental implants cost thousands of dollars and the cost of this procedure range somewhere from $1000 to $25,000. Thus Medicare beneficiaries are greatly concerned whether Medicare covers dental implants or not. Original Medicare that comprises of Medicare Part A and Part B generally does not include coverage for dental services. Dental care is only covered when it is associated with a medically necessary pre-operation visit for a heart valve replacement surgery or a kidney transplant. Besides those rare circumstances, Medicare enrollees have to pay out-of-pocket for their dental services. Medicare generally pays for the inpatient care, if a person has a complex dental procedure done in the hospital, although the dental procedure itself is not covered. Thus, it can be said that Medicare doesn’t cover dental implants, but may cover some services related to dental implants. If a dental implant surgery is carried out in a hospital, then the cost associated with the hospital stay may be covered. People need to understand that if their dental expenses are only restricted to dental procedures like cleaning or cavity filling, then these expenses are not covered by Medicare. However, if people need a dental procedure to treat another medical condition, then Medicare may cover it.
Dental Coverage under Medicare Advantage Plans
Medicare enrollees who wish to have dental care coverage should consider enrolling in a Medicare Advantage plan. Medicare Advantage plans offer the same coverage as Original Medicare and some additional benefits, including dental services. Some of the Medicare Advantage plans provide coverage for regular dental services like oral check-ups, cleanings, x-rays, and fillings, and some Advantage plans may even cover the dental implant costs. To avail of the dental care benefits, beneficiaries of Medicare Advantage plan have to obtain dental care from an in-network dentist, and their carrier may pay a certain amount of the dental care service cost, regardless of the actual cost of the dental care. Thus, Medicare enrollees looking for dental implant coverage will need to search for an Advantage plan in their area that offers dental implant coverage.
Does Medicare Cover Dental Implants?
People who are covered under Original Medicare are unfortunately not covered for dental implants or other major dental services. Medicare offers extremely limited dental coverage, and the only way they may pay for dental implants is as a part of a full mouth reconstruction. A full mouth reconstruction may be required by a person if he/she has experienced significant damage to the tissue or jawbone due to an injury or disease. Thus, it can be said that if medicare beneficiaries want to have dental implant coverage, then they either need to purchase additional dental coverage or find a Medicare Advantage plan that provides coverage for dental implants.
How to Find If Medicare Advantage Plan Covers Dental Implants?
Enrollees of the Medicare Advantage plans receive an Evidence of Coverage notice in which it is specified whether the plan pays for dental implants or not. The notice also states the way through which beneficiaries are required to pay for their prosthodontic services. Other than this,
Which Medicare Advantage Plans Cover Dental Implants?
Medicare Advantage plans vary widely, so people need to carefully research all the available options to understand dental implants’ availability and the extent of coverage for it. The Medicare Advantage Plan, Kaiser Permanente’s Senior Advantage Plus plan provides basic and major restorative dental services to enrollees after they meet a $50 dental deductible and pay 50% coinsurance up to a $1,250 annual benefit maximum.
Seniors who require dental implants will need to significantly pay for prosthodontic services along with their monthly premiums, copays, coinsurance, annual caps, and other out-of-pocket costs of their Medicare Advantage plan. Besides Medicare Advantage plans, they also have the option to either purchase a stand-alone dental insurance plan or a discount dental plan, if it is financially feasible. Seniors can also check their eligibility for free or low-cost dental implants through various charitable dental programs.
Coverage Options for Dental Implants
Now it is clear that both Original Medicare and Medigap plans do not offer dental benefits, so people are left with only two options to obtain coverage for dental procedures like implants. Individuals can obtain dental implant coverage either by enrolling in a Medicare Advantage plan that provides coverage for dental implants or they can enroll in a stand-alone dental plan that includes dental implants benefit. However, with both these options, people will require to pay a monthly premium, and they should also keep in mind that even with these dental plans, dental implants will cost them, as this is not fully covered under any plan. People will require to pay coinsurance, copayments, and deductibles while availing dental implant benefits.
On average, a single dental implant costs around $4,500 and if there is 20% coinsurance, then individuals will have to pay $900 from their pockets. However, this is not all, as their dental plans may also have a maximum annual benefit. The maximum annual benefit is an amount which the maximum amount which the dental carrier will cover in one year. For instance, if a dental plan has a maximum annual benefit of $1,500, then the dental carrier will not pay more than $1,500 and the individual will have to pay $3,000 from their pocket. Thus, people are advised to carefully shop for dental coverage and should look for dental plans with generous and affordable coinsurance. People should find a dental plan that has a maximum annual benefit that is apt to their dental expenses. People should know about the estimated cost of their dental implants from their dentists so that they can look for a dental plan that will allow them to save the most while opting for dental implants.
Dental implants may be required by people because they can lose their permanent teeth due to many reasons like advanced tooth decay, failed root canal therapy, and periodontal diseases. These are some of the common reasons and a person can also lose teeth in an accident. Thus, these people can opt for a dental implant, which is a permanent way to replace the missing teeth.
Dental implants come with many benefits, as of right from improving the quality of life to maintaining the structure of the remaining teeth to improving chewing ability, to building higher self-esteem in the person. Though dental implants are worth their cost but it is up to an individual to decide that whether the cost of an implant is worth its benefits or not.
People need to carefully plan for saving on dental implants with the help of a dental plan. While planning to go for dental implants, a person should know the number of teeth he/she need to replace, the cost of a dental implant in their area, whether they have any other dental or medical issues that may affect the cost of their dental implants. The person should consult with their dentist to know about the expected expenses of the implant. After knowing everything, the person should review stand-alone dental plans and Medicare Advantage plans that provide coverage for dental implants. The person needs to pay attention to the monthly premium, coinsurance, and maximum annual benefit. Keeping all these factors in mind, a person should find a dental plan that is overall most advantageous.
There are just two ways through which people can avail dental implant coverage. People can either buy a Medicare Advantage plan that provides coverage for dental implants or they need to buy a stand-alone dental plan that provides coverage for dental implants. However, people need to know that dental implants are not fully covered under any plan, and people are required to pay some amount from their pocket also to avail dental implants benefit.