Does Medicare Cover Dental Implants?

The answer might surprise you.

Most of us know that our teeth and gums are critical to our health.

Not only are they important for feeling and looking our best, but our teeth and gums also help us with socialization, in communicating clearly with our friends and loved ones.

Tooth decay has been linked to serious illness such as stroke, diabetes, dementia, and heart disease.  Untreated tooth decay can also delay or prevent treatment for chemotherapy, organ transplants, heart valve replacement and joint replacement among others.  So it's serious stuff.

Almost one in five adults of Medicare eligibility age (65 years old and older) have untreated cavities. The same proportion has lost all their teeth. Half of Medicare beneficiaries have some periodontal disease, or infection of structures around teeth, including the gums.1

Although traditional Medicare doesn't include “dental insurance”, it might cover some procedures that you aren't aware of.

Although Original Medicare benefits under Part A and Part B do not cover routine or cosmetic dental care, there are certain instances in which oral surgery qualifies for coverage with these benefits. These circumstances usually involve a covered medical condition that requires oral surgery as part of a broader treatment plan, as is the case with extracting damaged teeth before radiation treatment or organ transplant.2

Traditional Medicare will cover dental procedures that are integral to other covered services. So if your Medicare-covered hospital procedure involved dental structures in some way, important related dental care would be covered. But paying for any other care is up to the patient.3

For example, if you have a severe oral condition that threatens your overall physical health, you might be covered.

These conditions could include:

  • dental infections that could increase your risk for:
    • heart attack
    • heart disease
    • stroke
    • pulmonary infection
    • blood clots

Medicare might cover dental implants…or at least a portion of them.

If you have a condition that, if left untreated, would impact your health and well-being, you may be eligible to have a portion of your costs covered by Medicare. Generally speaking, only severe oral health conditions that threaten your overall physical health are considered medically necessary procedures. These conditions could include:

Dental infection that is threatening your physical health and increasing your risk for heart disease, heart attack, stroke, pulmonary (lung) infection, or blood clots

Gastroesophageal reflux or other stomach issues that result from a poor diet due to an inability to chew or consume healthy foods

Cysts or abscesses in the bone

Difficulty chewing food due to pain and lack of teeth4

But just because Medicare agrees that you have a covered-condition, you will still have significant costs that Medicare won't cover.  Does Medicare Cover Dental Implants?  Perhaps.  For example, 30-50% of your costs might be covered.

Even if Medicare determines that you have a condition requiring medical intervention, you will still be responsible for the remaining cost of treatment. While Medicare will not cover all of the fees needed for treatment, under specific conditions, 30 to 50 percent of your costs could be paid. This could translate to having up to $10,000 of your oral surgery treatment covered.5

Let's talk about how the dental implant surgery works:

Dental implant surgery is usually performed in different stages to allow the jawbone to heal around the implant.

First, if the damaged tooth is still in its socket, the dentist will extract it. If the oral surgeon recommends a bone graft procedure due to lack of adequate bone mass, this will be done first.

The jaw will need time to heal afterward.

The jawbone could take about three to six months to heal and be ready for the final stage of the implantation.

If the jawbone is not strong enough, the implant will inevitably fail, hence why patience is vital during treatment.

Once the bone heals, the implant will be inserted into the jawbone.

During the osseointegration process, the dentist will provide a temporary restoration to preserve the tooth’s appearance.

After healing and osseointegration, the dentist will attach the abutment.

This piece connects to dental implants and holds the artificial restoration.

The procedure is minor and usually done under local anesthesia. The surgeon can choose to install it immediately after placing the implant or to schedule a second procedure for placement.

Placing the abutment requires reopening the gums to expose the implants. The gum tissues will be stitched around the abutment and given one or two weeks to heal.

After the gums have healed sufficiently, the dentist will take new impressions of the mouth and existing teeth to create the new prosthetic tooth or crown for the implant.6

How is the oral surgeon able to get some of the costs covered by Medicare?

It depends on what the surgeon is doing, and whether he or she is a Medicare-approved provider.  Some procedures that are not normally covered might be covered if there are other procedures being done at the same time.

For example, the reconstruction of a ridge performed primarily to prepare the mouth for dentures is a noncovered procedure. However, when the reconstruction of a ridge is performed as a result of, and at the same time as, the surgical removal of a tumor (for other than dental purposes), the totality of surgical procedures is a covered service. Likewise, the wiring of teeth is a covered service when it is done in connection with the reduction of a jaw fracture if the reduction and wiring are performed by the same practitioner.7

Also, procedures and surgery must be medically necessary.

In 1990, the American Dental Association’s House of Delegates adopted the following comprehensive definition of medically necessary dental services:

the reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances, and devices) as determined and prescribed by qualified, appropriate health care providers in treating any condition, illness, disease, injury, or birth developmental malformations. Care is medically necessary for the purpose of controlling or eliminating infection, pain, and disease; and restoring facial disfiguration, or function necessary for speech, swallowing, or chewing.8

When I'm asked whether Medicare will cover a particular procedure such as dental implants, I actually can't answer that.  This is because it's not always easy to determine if a procedure will be covered by Medicare.  These types of procedures depend on the patient's needs.  Whether it will be covered can only be determined by a dentist who is a Medicare provider.  So does Medicare Cover Dental Implants?  Perhaps.  You'll need to talk with a Medicare-approved Dental Surgeon to find out.

A good rule of thumb is this: if your dental expense is related only to a dental procedure – such as a filling for a cavity — it won’t be covered by Medicare.

If, however, you had to have a dental procedure in order to treat another medical condition, it might be covered by Medicare.9

Changing Plans:

If your oral surgeon has recommended that you contact my office, here is some information that you need to know:

  • Before making any changes, please watch this 15-minute video on the differences between Medicare Advantage and Medicare Supplement Insurance (Medigap):  http://MedicareQuick.com/MMD
  • If you are changing from an MAPD to a Medigap plan, you can only do so during the Annual Election Period (AEP) which is between October 15th and December 7th.  You can also change plans if you have a Special Election Period (SEP)
  • If you are on Medi-Cal (Medicaid) and have 100% share of the cost, insurance companies CANNOT sell you a Medicare Supplement Plan (Medigap).  Even if they could sell you a Medigap plan, these procedures are normally not covered by Medicare at 100%.  Medicare might only cover $10,000 out of a $35,000 procedure.  So in this example, you'd need to come up with the other $25,000.  It's unlikely that a person with 100% share of cost has that kind of money to cover the costs not associated with Medicare.
  • If you have Kaiser* and change to original Medicare, you will need to get new doctors.  Kaiser only accepts its own plan for Medicare Advantage.  They do not accept original Medicare Part B.
  • Even if your procedure is partially covered by Medicare, it is likely that you will still be responsible for a significant portion of your dental implant costs.  Talk with your oral surgeon to find out what your total costs might be.

Once you have this information, please feel free to contact me at 866-445-6683 or use our contact form.

  1. Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem. – The New York Times, Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem. Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem., https://www.nytimes.com/2018/03/19/upshot/medicare-missing-dental-coverage.html
  2. Does Medicare Cover Oral Surgery?  | Medicare & Medicare Advantage Info, Help and Enrollment, Does Medicare Cover Oral Surgery? https://www.medicare.org/articles/does-medicare-cover-oral-surgery/
  3. Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem. – The New York Times, Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem. Medicare Doesn’t Equal Dental Care. That Can Be a Big Problem., https://www.nytimes.com/2018/03/19/upshot/medicare-missing-dental-coverage.html
  4. Medicare – Bridgewater, VA – Smiles For Life – Dr. Joe McIntyre, Does Medicare Cover Dental Treatments? https://www.smilesforlifeonline.com/about-the-practice/medicare
  5. Medicare – Bridgewater, VA – Smiles For Life – Dr. Joe McIntyre, Does Medicare Cover Dental Treatments? https://www.smilesforlifeonline.com/about-the-practice/medicare
  6. Medicare Covered Dental Implants – Beltran Dental Surgery Temple Terrace Florida, Medicare Covered Dental ImplantsTemple Terrace, FL, https://www.beltrandentalsurgery.com/temple-terrace-fl/medicare-covered-dental-implants/
  7. Appendix C: Medically Necessary Dental Services | Extending Medicare Coverage for Preventive and Other Services | The National Academies Press, Extending Medicare Coverage for Preventive and Other Services (2000), https://www.nap.edu/read/9740/chapter/12#226
  8. Appendix C: Medically Necessary Dental Services | Extending Medicare Coverage for Preventive and Other Services | The National Academies Press, Extending Medicare Coverage for Preventive and Other Services (2000), https://www.nap.edu/read/9740/chapter/12#223
  9. Does Medicare Cover Dental? (Dentures, Oral Surgery, Wisdom Teeth), Medicare Dental Coverage, https://www.medicarefaq.com/faqs/what-dental-expenses-does-medicare-cover/

 

*Neither Kathe Kline nor MedicareQuick is affiliated with Kaiser.  Please contact Kaiser directly if you have any questions about their plan offerings.

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