If you’ve been thinking about improving your dental health, you may be asking: does Medicare cover dental implants? The answer is a bit complicated. For the most part, Medicare will not cover standard dental procedures unless an emergency or complication occurs that justifies dental treatment. This includes dental implants. But don’t fret – this article will offer solutions to mediate this problem.

Key Takeaways

  • A dental implant is a procedure that replaces missing or damaged teeth.
  • Original Medicare (Parts A & B) does not cover dental implants, but it’s possible to obtain coverage through Medicare Advantage (Part C).
  • Medicare will only cover dental treatments in the event of an emergency where dental treatment is necessary.
  • Medicaid and other private dental insurance providers may cover dental implant procedures.
  • Some dental provider organizations offer dental discount cards for recipients to use on various dental services.

Dental Implants

A dental implant is a medical procedure in which the tooth roots are replaced with metal cylinders in order to replace any missing or damaged teeth. These implants serve as artificial teeth with the same function as regular ones. This procedure is conducted after an extensive review of your medical history, thorough dental examinations, and a proper treatment plan catered to your own needs. Recipients of this procedure develop reinforced teeth following the operation.

Does Medicare Advantage Cover Dental Implants?

While Original Medicare (Parts A & B) won’t cover dental implants, it’s possible to obtain coverage through Medicare Advantage. Medicare Advantage, otherwise known as Medicare Part C, is a type of private health insurance plan which can offer bundles of Medicare Part A and B benefits.

Coverage for prescription drugs and dental plans that would typically not be offered under Original Medicare are covered under Medicare Advantage. Given how diverse the insurance plan marketplace is, choose the insurance plan that provides the best dental coverage option.

What Other Services Does Original Medicare Cover?

In the event of an emergency, there is a possibility that Original Medicare will cover necessary dental procedures. Original Medicare will provide you coverage under the following circumstances:

  1. Accidental damage to the jaw that requires immediate surgery
  2. The emergence of disease which compromises your gums or teeth
  3. Prior to any treatment or surgery, a dental check-up is warranted in order to prevent and detect any condition that threatens your procedure

After an individual has met any of the conditions stated above, then they’ll automatically become eligible for dental coverage through Medicare Part A. Medicare Part A is the hospital insurance portion of Original Medicare, which provides inpatient hospital care in a wide array of treatment centers. As long as you’re hospitalized in one of these centers, Part A covers the costs of any dental procedure that would normally come out of pocket in Original Medicare.

Dental Services Excluded By Original Medicare

The dental services that Medicare doesn’t cover on a general basis include:

  • Tooth extractions
  • Dental implants
  • Dentures
  • Dental cleanings
  • Tooth fillings
  • Dental plates

Since Original Medicare doesn’t cover these services, you would be paying 100% out-of-pocket for these services.

Alternative Dental Coverage Options

There are options outside of Original Medicare available to the people struggling to find dental coverage. Beyond Medicare Advantage, these following programs offer dental coverage in either limited or full capacity:

Medicaid

Medicaid is a federal and state-funded public assistance program catered towards helping those in financial need. The functions of this program, although dictated to a certain degree by federal guidelines, will vary widely depending on your state. To qualify for Medicaid, you must be:

  1. Certifiably blind or someone with a disability within a certain age range
  2. Low-income and under the age of 65, or a minor under the age of 18
  3. Pregnant or expecting a child
  4. A minor living alone, or the parent of a minor with financial needs

Under Medicaid, dental coverage rules are dependent on several things. For instance, Medicaid requires that all states must provide dental services to children, which is covered through both Medicaid and the Children’s Health Insurance Program (CHIP). However, in contrast to mandated dental coverage for children, the coverage for adults will be dependent on the state.

With this in mind, the majority of states do offer coverage for emergency dental services, while less than half barely offer appropriate dental care service. Fortunately, despite the limitations, there are no minimum requirements for an adult to qualify for dental coverage.

Purchasing Dental Insurance

One of the easiest methods of acquiring dental coverage is through searching the Health Insurance Marketplace. Not only can you acquire individual dental insurance, but you also have the option of purchasing group dental policies.

When browsing in the Marketplace, keep in mind the many factors that will affect the services and costs of your dental plan. From strict network limitations to varying premiums, co-payments, and deductibles, it is crucial that you optimize your search by choosing the plan that covers your basic needs.

Dental Discount Cards

Finally, when seeking an alternative source of dental coverage, you can always utilize a dental discount card. These discount cards are offered on behalf of some dental provider organizations outside of Medicare and standard dental insurance. Since these cards work outside of Medicare and dental insurance coverage, then you will be paying for the full cost of dental treatment (but at a discounted price).

With a dental card, recipients gain access to a vast network of dental providers. They can partake in any of the services offered such as tooth extractions, dental implants, and cleanings, among other things. In order to acquire the card, you must pay a one-time annual fee. You can then use the card with a dental provider.

Choosing the Right Option For You

While Original Medicare doesn’t usually cover dental implants or other dental treatments, you still have the option of finding coverage. With alternatives like Medicaid, Medicare Advantage, and discount dental cards, it’s almost impossible to not find dental coverage. Above all, remember to carefully weigh the pros and cons of each alternative to find the most suitable one for you.

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