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.