It’s a common question that’s asked when it comes to medicare, and unfortunately, it does not have a positive answer. Under Original Medicare, you do not get dental care. Therefore, they don’t provide cleanings, fillings, extractions, dentures, tooth extractions, or permanent prosthetics like implants.
The only dental care offered on Original Medicare is under emergency health procedures requiring dental in hospital situations. However, that does not mean you cannot have an insurance plan to cover dental implants when enrolled in Medicare. If you choose to get such a plan, you can get partial or full coverage for dental procedures, rather than having to cover the full cost yourself.
We’ll take you through what options you have to cover dental implants under Medicare, the dental procedures that are covered, and what many Medicare Advantage plans do cover when it comes to dental care.
How to Cover Dental Implants Under Medicare
If your dentist has suggested a dental implant, you should know that Medicare doesn’t cover dental care costs or vision and hearing coverage. Here is a brief guide to getting coverage for your dental implants.
What Are Dental Implants?
When you lose one or several teeth, your dentist may recommend replacing them with artificial teeth instead of dentures. Implants fall under prosthodontics, a branch of dentistry. They require several procedures to place the titanium screw and an abutment that will hold the crown part of the implant to the jawbone.
Implants have become the ideal substitute for missing teeth because they are durable and function like regular teeth.
What does a Medicare Advantage Plan cover for dental implants?
Before reaching the stage of having dental implants, you need examinations, x-rays, and tooth extractions.
A Medicare Advantage plan with dental benefits typically covers examinations and x-rays. Tooth extractions may be partially covered, depending on your plan. Some plans cover crowns, but not when they are associated with dental implants.
Since most dental implant procedures are outpatient, the Medicare Advantage dental plan may partially cover anesthetic or nitrous oxide costs. If your plan pays for dentures, you should determine if you can apply the benefits to dental implant costs.
Therefore, always determine which dental benefits a plan includes.
What about your medications?
You will require antibiotics and pain medications pre- and post-procedure with implant surgery. These are covered by the drug benefit of your Medicare Advantage plan or standalone drug coverage Part D if the medicines are on the plan’s formulary. In addition, you will have copay or coinsurance costs, depending on the tier of drug prescribed.
How to get Medicare Coverage for Dental Implants?
Since you don’t get any dental services from Original Medicare, you need to look for a Medicare Advantage Plan with dental services. However, some of these only include annual examinations and cleans, so you must ensure that it covers other dental services, including extractions, replacements, and implants.
When opting for coverage that includes dental implants, you may have an additional premium and a maximum dental benefit. There will also be an out-of-pocket amount with a copay or coinsurance. Of the plans that cover dental implants, some don’t cover the required surgical placement of the metal post.
You will need to read the Evidence of Coverage document of the plan to find out the list of procedures covered. However, the terminology and codes used in the documents are often quite confusing, so you need to have someone who understands these explain them to you; usually, a dental provider or experienced insurance agent understands them best.
Visit this Page for a Comparison of all Medicare Supplement Plans
What Dental Procedures Are Covered by Medicare?
In some cases, Medicare will cover a dental procedure and hospital stay related to an injury or illness. For example, when losing a tooth in an accident or the loss is connected to a health condition. It may also cover procedures that arise because of complications to Medicare-covered procedures. Medicare will also cover any medications required under these circumstances.
Furthermore, Medicare Part A will cover certain dental procedures if they are necessary for another health service which Medicare does cover to be successful. These include oral examinations required before kidney transplants or heart valve replacements. Dental procedures which are necessary for radiation will also be covered, as well as ridge reconstructions and dental splints required after jaw surgery.
How to get dental insurance
Seeing as Medicare does not really cover many dental procedures, especially implants, you may want to consider different dental insurance options. Take a look here to see which Medicare Advantage and Medicare Supplement plans will give you the most benefits.
When looking for the best plans in New York state, you can search the Medicare website, speak to a dental provider, or contact us at The Modern Medicare Agency for help.