Medicare does not cover dental implants for the average patient. In fact, Medicare does not cover most types of dental care, with the exception of a few limited conditions. You are responsible for paying for implants and other dental procedures 100% out of pocket.
There are exceptions, but they’re few and far between. For example, Medicare might pay for dental implants if they’re part of another covered medically necessary procedure, such as if you get jaw surgery and the implants are needed to hold a medical prosthesis in place. But if you need implants to fill in the gaps where you’re missing teeth, Medicare will not provide coverage.
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How Do Dental Implants Work?
Dental implants are different than dentures, which sit directly on your gums or bridges. In contrast, implants are fastened into your jawbone underneath the gum, making them nearly as stable and sturdy as your original teeth.
During a dental implant procedure, a surgeon cuts the gums to access the bone underneath. They then use a drill to create a hole in the bone. Next, they insert a titanium post into the bone. Over time, this metal fuses with the jawbone, securing it further. Eventually, the surgeon attaches the post to an abutment, the implant piece that sticks out of the gum. The abutment is where the crown is attached.
As long as you have enough bone, you can use dental implant procedures to replace one, a few, or a whole row of missing teeth. Unfortunately, neither Medicare Part A nor B covers this procedure. However, many Medicare Advantage plans do.
When Does Original Medicare Cover Dental Implants?
There are a few instances when Original Medicare might cover dental procedures:
- When you’re hospitalized or about to be hospitalized because of a medical condition affected by or could be affected by your dental health.
- When a dental procedure is so severe that it requires hospitalization to complete.
Some examples of these instances might include:
- You need a dental or oral exam before an organ transplant, cardiac valve replacement, or valvuloplasty to treat any dental infections.
- You’re having dental ridge reconstruction at the same time you’re having a tumor removed.
- You need to stabilize or immobilize your teeth to help heal a jaw fracture.
- You’re getting a dental splint placed to fix a dislocated jaw.
- You’re having teeth extracted to prepare for cancer radiation treatment.
How Does Medicare Advantage Cover Dental Implants?
You may get reimbursement for routine exams and procedures if you have a Medicare Advantage plan with dental health coverage. However, it will depend on your specific plan’s policy.
If you visit the dentist regularly, enrolling in a Medicare Advantage plan could save you a lot of money in the long run. To get help finding a plan, speak with a trusted agent who can match you with a plan that meets your needs.
How Much Does Dental Surgery Cost?
If you’re considering implants, the average cost is between $3,000 and $4,500 per tooth. For a whole mouth of implants, it could be as high as $45,000. Fortunately, if you have dental coverage through Medicare Advantage, costs are typically much more affordable.
Medicare Dental Care Costs With Medicare Advantage
Here’s how your dental implant costs might break down with a Medicare Advantage plan:
- Monthly premiums: This is the monthly fee you pay to the insurance company to keep your coverage active. In 2023, the average premium is $18. This premium is paid on top of any Part A and B premiums you may owe, though the majority of Medicare beneficiaries receive premium-free Part A.
- Part A deductible: Since dental benefits are covered under Part A, you must pay your deductible before coverage kicks in. In 2023, it’s $1,600 for each benefit period.
- Copays: This is a set fee you might pay your surgeon for each visit.
- Coinsurance: Likely, your insurance company has a set percentage you must pay for any procedure you receive. This is often 80-90% coverage, meaning the beneficiary will pay the remaining 10-20%.
- Out-of-pocket maximums: This is the max amount you pay before your remaining bills for the year are covered at 100%.
- Out-of-network costs: Your Medicare Advantage plan has its own health network of healthcare providers, including dentists. If you go outside that network, you may pay a higher percentage of the bill.
How to Find Coverage for Dental Care
While Medicare Advantage plans may offer dental care coverage, there are other ways to get coverage for dental care. Consider one of the following options:
Private Dental Insurance
Private dental insurance is a standalone plan, meaning it’s separate from your other health insurance. Routine procedures like oral exams are usually covered at 100%, but other procedures like crowns or dental implants might be covered at 50% or 80%, with you footing the rest of the cost. You may also need to pay a deductible before coverage kicks in, which usually averages between $25 to $100. Finally, you must also pay a monthly premium, which averages between $14 and $35 for many adults.
Dental Discount Plans
A dental discount plan is like a discount program for a select group of dentists. The plan provider negotiates with its network to determine agreed-upon costs for specific procedures. When you visit the dentist and receive treatment, you pay this agreed-upon fee directly to the dentist. This differs from regular insurance, where the dentist bills the insurance company. Premiums can be up to $12 a month and usually cost around $200 a year, providing patients an average savings of 40% on dental services.
Medicaid
Medicaid is a state-managed health insurance program for low-income or disabled adults. If you’re eligible to receive Medicaid coverage, you may get access to dental benefits, but it depends on the state and county in which you live. While there are some federal guidelines state Medicaid programs need to follow, dental coverage is not included in them. To know if your state offers adult dental benefits, check directly with your local Medicaid office.
Weighing Your Options for Dental Care
If you need coverage for dental care, it makes sense to look outside of Original Medicare. Medicare Advantage is a viable option, and premiums are quite affordable. However, you can only switch to one of these plans during certain times of the year, so it takes some planning. Depending on how you’re getting private dental insurance (such as through your employer or on your own), you may be able to join any time of year. The same goes for a dental discount plan and Medicaid, so long as you’re eligible.
Plan | Coverage | Cost | Service Availability |
|---|---|---|---|
Original Medicare | Very limited; only covered in specific circumstances | Part A premium is free for most people | Nationwide; can go to any hospital that accepts Medicare |
Medicare Advantage | Varies by individual plan and insurer but often includes routine dental care and dental procedures | Separate premium; average is $18 per month as of 2022 | Subject to plan network |
Private dental insurance | Varies by individual plan | Premiums average between $14 to $35 a month | Subject to plan network |
Dental discount plan | Varies by individual plan | Premiums can be up to $12 a month | Only available at specific dental offices |
Medicaid | Varies based on state’s rules | Free | Statewide; can go to any dentist that accepts Medicaid |
What This Means for You
Having dental benefits as you age is crucial for keeping your teeth healthy, so you do not need implants. Unfortunately, despite research linking poor oral health to diseases like Alzheimer’s and diabetes, Original Medicare does not cover routine dental procedures that could keep your teeth from falling out.
If this lack of insurance means you now need dental implants, there are a few ways to get coverage. Certain Medicare Advantage plans, private dental insurance, or even a dental discount plan, could help you save big on this expensive procedure. Consider speaking to a trusted Medicare agent for more help navigating the dental insurance landscape.