Are you one of the many Medicare beneficiaries who are in need of dental implants? You probably have some questions such as, “Does Medicare cover dental implants?” and, “Do Medicare Supplements cover dental implants?
Does Medicare Cover Dental Implants?
If you have coverage under Medicare, then you are probably enrolled in Medicare Part A and Part B. Unfortunately, Medicare Parts A & B typically won’t provide routine dental services including dental implants. In other words, you will not have coverage for the majority of dental services.
Medically Necessary
Original Medicare will only pay for care that is determined to be medically necessary. For example, Medicare would pay for situations such as:
- Surgery for a broken jaw
- Treatment for oral cancer
- Hospitalized due to a dental-related issue
- Pre-op dental exam visits for kidney transplant or heart valve surgeries
- An infected tooth that required extraction. Medicare would pay for the extracted tooth, but not for the replacement of that tooth.
If you have a condition like the examples above — that, left untreated, will impact your health, then you may be eligible to have a percentage of your costs paid by Medicare. It’s important to emphasize that only severe oral health conditions that will threaten a person’s overall physical health will be considered a medically necessary procedure.
Medicare may pay for dental implants in rare situations
When we’re asked if Medicare will pay for a specific service or procedure like dental implants, we often can’t provide a specific answer. The reason is because Medicare procedural coverage is not always easy to determine. In other words, there are so many types of procedures that will depend specifically on each patient’s unique needs.
Does Medicare cover Dental implants? It’s very unlikely, but may be possible depending on your unique situation.
You’ll need to discuss your situation with a Dental surgeon who is a Medicare-approved provider to find out. Whether a specific dental implant procedure will be covered by Medicare can only be determined by your dentist or oral surgeon.
A good rule to follow is this: if your dental procedure is routine or related only to a typical dental procedure (like a cavity or a filling) then it will not be covered by Medicare.
However, if you need to have a dental surgery or procedure to treat another medical or health condition, then it might be covered by Original Medicare.
Do Medicare Supplements Cover Dental Implants?
Your Medicare Supplement plan, also referred to as Medigap, helps pay for the gaps in coverage that Original Medicare won’t pay. These are things such as copays and coinsurance that occur with Original Medicare.
A Medicare Supplement plan works with Original Medicare and will only pay for services that are approved by Medicare. As we mentioned previously, Original Medicare will not pay for the majority of dental care. If Original Medicare does not approve a dental procedure, then a Medicare Supplement will not pay.
However, if your dental procedure is medically necessary and Original Medicare approves it, then your Medicare Supplement plan will pay its portion.
