Your smile is the first thing people see when they meet you. A smile conveys emotion, and many people want to get better, healthier, and whiter teeth. Many people turn to dental implants to get the healthy teeth they want. If you are a senior looking to improve your smile and get dental implants, you may wonder if Medicare will cover the cost for you.
Does Medicare cover dental implants? According to Forbes Health, Medicare does not cover the cost of dental implants. Some people may be put off by this, especially when they want to improve the appearance of their teeth. However, certain Medicare Advantage plans cover the cost of dental implants.
If you are considering signing up for a Medicare Advantage Plan for this reason, it is important to read the specific guidelines of your policy to determine if dental implants are covered before signing up for a policy.
According to experts, roughly 24 million people do not have dental insurance—a fact that can lead to tooth decay, cavities, and inevitably, high dental bills. If you decide to sign up for a Medicare Advantage Plan to get dental insurance, you should decide whether you want a Medicare Advantage Plan or a Medicare supplemental plan, such as Medigap.
You can purchase Medigap from a “private insurance company.” A supplemental insurance plan will cover the cost of medical expenses that would otherwise come out of your pocket. However, to buy a Medigap policy, you must already have Original Medicare, which includes Medicare Part A and Medicare Part B.
Medicare Part A covers hospital visits and stays, while Medicare Part B covers other medical expenses. Original Medicare does not cover dental procedures, supplies, or care. If you have Original Medicare, you are responsible for the cost of extractions, fillings, and routine dental cleanings. However, you can buy a low cost Dental, Vision & Hearing plan covering these procedures.
However, Medicare Part A will pay for some “medical dental services” that are rendered during a stay in the hospital. If you sustained a mouth or jaw injury, Medicare Part A will cover the cost of procedures that are needed to fully recover. While Medicare does not cover dental implants, you can find another plan that will assist you in paying for dental implants.
Although Original Medicare does not cover the cost of dental implants, you can do a number of things to get Medicare to cover the cost of dental implants. Rules regarding dental coverage can be quite complex, when it comes to dental coverage and your network. But what exactly are dental implants?
According to experts, dental implants are essentially fake teeth that are implanted into the gum. They are used to replace lost or damaged teeth. A screw replaces the root of your tooth, and the screw is affixed in your jaw. Then, a crown is placed over the screw. Dental implants feel and look like your natural teeth, even though they are fake.
You can get different types of dentures on dental implants. These include removable dentures, hybrid dentures, and permanent dentures. Getting dental implants is pricey, and in many cases, costs as much as $25,000 in total. The cost will ultimately depend on the condition of your teeth.
The procedure itself is an operation on your jaw. It may require numerous follow-up visits, which can also be expensive. The procedure in itself may take place over time and may require multiple individual procedures. You must be enrolled in a plan for “several months” before you are able to get coverage for dental implants. This process usually takes one full year.
You will also need insurance that will cover the cost of prescription drugs, such as painkillers. Medicare Advantage Plans can be beneficial for those who want dental implants. Also called Medicare Part C, MA or Medicare Advantage plans can be used to pay for dental implants. You can get coverage for dental implants by adding a dental plan to your MA coverage. However, there a typically significant waiting periods before the procedure will be covered.
The cost for this coverage is generally low, and some of these plans provide discounts on vision and dental insurance plans. It is important to read the details of dental insurance plans before you pick one. Some plans provide graduated coverage. Coinsurance costs are usually high within your first year of coverage, and it is important to understand how this process works.
Generally, the price of coinsurance decreases as time goes by. This is a gradual process. But how does price fluctuate throughout the year?
According to Insurify, Medicare Advantage covers 50 percent of dental costs, while coinsurance covers the other 50 percent. During the second year, Medicare Advantage covers 65 percent of dental costs, while coinsurance pays for 35 percent of your expenses. MA coverage rises to 80 percent in your third year, and coinsurance covers the remaining 20 percent. This, of course, varies by the specific plan.
Since Original Medicare does not cover the cost of dental implants, you are left with two options to get coverage for this procedure. You can get an individual insurance plan that covers dental expenses (often sold as Dental, vision and hearing plans) or you can get a Medicare Advantage plan that covers dental expenses. You will most likely have to pay a premium each month.
Although insurance will cover some of the cost, you will still be responsible for any balances your insurance doesn’t cover. This can be costly and can be a huge financial burden. You are ultimately responsible for any remaining balance, and you will still have to pay for deductibles, copays, and other costs.
A single dental implant can cost $4,500. If coinsurance covers 20 percent of that cost, you will still have to pay $900 to cover the balance that’s not paid by your insurance company. In some cases, there is a cap on your maximum benefit. Once you’ve reached that cap, your insurance company will not cover the remaining cost, and you must pay for the rest out of pocket.
If your insurance company will only cover $1,200, you will have to pay an extra $3,300. Collectively, these come to a total of $4,500. If you are shopping around for dental insurance, be on the lookout for affordable insurance plans that cover the majority of your dental costs. Make sure that the insurance company’s maximum benefit lines up with your expected medical expenses.
According to the United States Department of Health & Human Services, dental care is required and is an essential factor “for the Early and Periodic Screening Diagnostic and Treatment” or EPSDT benefit. However, not all individuals aged 21 and above are eligible for coverage. Who gets coverage is determined by the state in which one lives.
Some states choose to offer dental care, while other states do not. Your Medicaid provider will be able to provide you with more information regarding your insurance company’s approach to dental coverage. It may help to speak with your Medicaid provider to find out what options you have to choose from.
But why exactly do people get dental implants? According to insurance experts, people often get dental implants if they have tooth decay, periodontal or gum disease, or if they received a failed root canal. Tooth loss that results from a break in one’s tooth can cause some people to want dental implants.
Dental implants are highly desired, primarily because they are a permanent replacement for lost or damaged teeth. They also look real, so people will not be able to tell that your teeth are artificial. Dental implants are definitely a worthwhile investment. Not only do they look good, they also help your remaining natural teeth to stay properly in place.
If you want dental implants, you may be looking for the best way to save money on dental implants. If you want to save money, you need to figure out how you can wait before the implants are necessary. You may also want to consider the cost of dental implants in the area in which you live. Other conditions and dental procedures you require can influence the cost of dental implants.
It may also help to speak with your dentist to see if you need to plan for other dental expenses or procedures. Once you have this information, you can look at Medicare Advantage plans and other dental insurance plans. Look at the cost of premiums, coinsurance rates, and the maximum annual benefit.
It may also help to get dental implants over an extended period of time. Schedule several appointments over a timespan between fillings, crowns, and follow-up appointments. It may help to get implants over the course of one year, so you are not bombarded with high costs all at once. Plus, your treatments are consistently covered.
If you have a Medicare Advantage plan, it is a good idea to see if your plan covers dental expenses. If your Medicare Advantage plan covers dental care, see if it covers dental implants. Not all Medicare Advantage plans offer coverage for dental implants. Many of these plans cover only routine checkups and cleanings.
There are drawbacks to getting dental insurance for implants through Medicare Advantage. While Medicare Advantage offers a lot for free, you are responsible for any other costs, such as copays, tests, and expenses that Medicare Advantage does not cover.
7 Sources
MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.
https://www.forbes.com/health/medicare/does-medicare-cover-dental/
https://www.medicare.gov/health-drug-plans/medigap
https://www.medicare.gov/glossary/o
https://insurify.com/health-insurance/knowledge/does-medicare-cover-dental-implants/
https://www.vspdirect.com/vision-hub/best-vision-dental-insurance
https://fairsquaremedicare.com/articles/will-medicare-cover-dental-implants