Which Medicare Advantage Plans Cover Dental Implants? Find Out Here!
Tooth loss is a prevalent oral health issue among mature adults. Around seven million American seniors over 65 don’t have any of their natural teeth. Tooth loss can result in numerous negative effects, such as loneliness and reduced quality of life.
There are many tooth restoration options to help seniors achieve a healthy smile. One of these options is dental implants. If you’re an elderly American dealing with tooth loss, you might be asking yourself “Which Medicare Advantage plans cover dental implants?”
We understand that navigating health insurance plans can be complicated, especially if you’re doing it on behalf of your loved one. This blog will talk about Medicare dental coverage. We’ll also look into which Medicare Advantage plans may or may not cover the cost of getting dental implants.
Which Medicare Advantage Plans Cover Dental Implants?
Original Medicare (Parts A and B) doesn’t cover dental implants. There are some Medicare Advantage plans (Part C) that offer dental insurance. This insurance may help with the cost of dental implants.
Keep in mind that Medicare Parts A and B may help with some costs associated with dental implants. Let’s discuss the coverage options you might find in Medicare Advantage plans.
Original Medicare
Medicare Parts A and B generally don’t cover dental services. The exception is if the dental services are related to an injury or illness. For example, Original Medicare plans may cover costs if health problems arise after you get your dental implants.
You’ll pay the entire cost of your dental implants if you have Original Medicare. Even if your insurance covers related medical coverage for complications, it won’t do anything to reduce the original cost of your procedure.
Medicare Advantage
Medicare Part C is a Medicare Advantage plan that provides seniors with dental care options. This plan is your best solution if getting coverage for dental implants is your goal.
The providers under the Medicare Advantage umbrella are private insurers. This means that these companies can offer additional benefits beyond the minimum Medicare requirements. You will typically have to pay a higher premium to get dental coverage.
Coverage of Dental Implants in Medicare Advantage Plans
You’ll need to carefully review your plan information to see if it’ll cover dental implants. All Medicare Advantage plans differ, so there are different ways the procedure can be covered. Let’s discuss some coverage options you might find with Medicare Advantage plans.
Limited Coverage With an HMO
For example, an HMO plan may offer 20 to 50% off various procedures, such as dental surgery. You may need to get prior approval from your insurance company before you move forward. You also may have limits on how much your insurance company will cover each year.
Partial Coverage With a PPO
A PPO plan may provide beneficiaries with partial coverage for dental implants. They could cover 50% of your procedure if you go with an in-network doctor. Your insurance might cover 25% if you book with an out-of-network oral surgeon.
70% Coinsurance With Approval
Another insurance plan may provide individuals with 70% coverage for dental implants. You may need to get prior approval from your carrier and a referral from your primary care doctor before you get the procedure.
Specific Plans That Cover Dental Implants
As mentioned earlier, Medicare Advantage plans are offered by private insurers. Most insurance companies offer Medicare Advantage plans. Some of the insurance plans that may cover your dental implant procedure include:
- Kaiser Permanente Senior Advantage Plus
- UnitedHealthcare
- Aetna
- Humana
- Cigna
Costs Associated with Dental Implants Under Medicare Advantage
The final cost of dental implants varies from patient to patient. Dental implants are comprised of many components and each part has its own cost. Some of the aspects of dental implants include:
- Dental exam
- Installation of dental implants
- Tooth extraction, if needed
- Creation of dental crown
- Anesthesia
- Placement of implant hardware
- Crown placement
The cost of one implant could be around $4,800. This price includes the surgical placement and the implant device. A full mouth replacement could cost at least $60,000.
Dental implants are costly because of the complex procedure. The implant materials also greatly affect how much you pay.
How to Determine If Your Plan Covers Dental Implants
Medicare Advantage plans provide beneficiaries with an Evidence of Coverage notice. This document states whether or not they’ll pay for dental implants. The notice will also let you know how much you’d have to pay for those types of dental services.
You can also get in touch with your insurance provider if you don’t understand the Evidence of Coverage document. You can ask them several questions in addition to finding out if they cover the procedure, such as:
- The extent of their coverage
- If there are any waiting periods
- Checking the Evidence of Coverage Notice
Mature adults can also use the Medicare Plan Finder tool to look up Medicare Advantage plans. All they have to do is input their zip code to get started.
Once you see a plan you like, click on “Benefits.” Medicare Advantage plans that have dental coverage will have colored circles. You can also review which dental providers are in their network.
Factors Influencing Dental Implant Coverage
How much your dental plan covers your procedure depends on your policy’s terms and conditions. Most dental care plans categorize healthcare procedures into three different categories:
- Preventative
- Basic
- Major
A few factors play a part in whether or not the procedure is covered by your plan. Many dental insurance plans have limitations or exclusions related to dental implant coverage. Insurance companies will also look at the cost-effectiveness of covering the procedure versus other types of treatments, such as bridges or dentures.
Other elements that may impact coverage include:
- The expected lifespan of the implant
- The beneficiary’s overall health
- The necessity of dental implants to restore teeth
Insurance companies may not be apt to cover dental implants if the patient is seeking them out for cosmetic reasons. They’re more likely to cover dental implants if it’s a medical necessity.
Dual Eligibility for Medicare and Medicaid
Some seniors with Medicare may also qualify for Medicaid. Another term for these individuals is “dual eligible.” Around 12.5 million people are enrolled in both types of plans.
Medicaid plans very often don’t fully cover dental implants. Medicaid might cover certain dental procedures, depending on why you need it.
A few reasons why your dentist might say dental implants are medically necessary include:
- You lost teeth in an accident
- Your missing teeth make it hard to sleep, chew, or speak
- You’re dealing with quality-of-life problems
If your doctor includes dental implants as part of the plan to reconstruct your smile, you may get coverage from Medicaid for your procedure.
Explore Alternatives and Supplemental Options for Dental Implants
You may already have Original Medicare and have decided against getting Medicare Advantage for the dental benefits. There are stand-alone dental insurance plans available for you to purchase. Different dental insurance plans will offer varying levels of coverage for various premium amounts.
Anthem
Anthem’s Essential Choice PPO Silver provides seniors with 50% coverage for dental implants and cost-effective monthly premiums. Keep in mind that there’s a six-month waiting period after you sign up for this plan before you can pursue dental implants. A downside of this plan is that there’s a maximum coverage amount of $1,000, which is lower than other types of insurance.
Guardian
Guardian Care’s monthly premium is significantly below the average for insurance policies that cover dental implants. The plan covers up to 50% of dental implants but comes with a $700 lifetime max. There’s also a year-long waiting period before you can get implants.
UnitedHealthcare
UnitedHealthcare was one of the plans we talked about where seniors can get dental coverage with Medicare Advantage. Their DentalWise 2000 plan has a $ 1,500 lifetime maximum benefit for dental implants. You also don’t have to deal with a waiting limit before you get the procedure.
Spirit Dental
Spirit Dental’s Spirit Core PPO doesn’t have a waiting period for dental implants. However, it only covers 25% of the procedure during your first year and 50% of it after that. There’s also only a $100-lifetime deductible instead of resetting each year.
Free or Low-Cost Implants From Charities
Many charity organizations offer low-cost or free dental implants to seniors and veterans. For example, the Program of All-Inclusive Care for the Elderly (PACE) is a community-based program that works with older adults. They may cover the cost of dental implants if they’re not covered by Medicare or Medicaid.
Veterans can also get free dental implants through various initiatives, including:
- Smile Veteran
- VA dental care
Connect with your local senior center to find out your options.
Frequently Asked Questions
As you can see, figuring out Medicare coverage when it comes to dental implants can be confusing. We’ll cover some of our most frequently asked questions to provide more clarity surrounding the topic.
What’s Cost-Sharing?
You may find some Medicare Advantage plans that could cover dental implants with a cost-sharing method. Cost-sharing refers to dividing the cost of a dental service between the insurance plan and the patient. It can be challenging to determine the cost of a procedure beforehand, which makes this option complex.
How Do I Get Medicare Advantage?
You can apply for Medicare Advantage through an insurance company or the Medicare website. Individuals can apply for a Medicare Advantage plan during the seven-month enrollment period around their 65th birthday. These individuals will need to be enrolled in Medicare Parts A and B first.
Individuals can also switch plans or sign up during the yearly open enrollment period. This period is from October 15 to December 7 every year. Your Medicare Advantage coverage will start on January 1 if you choose this option.
Can I Use Medicare Part D?
Medicare Part D is designed to cover prescription drugs. This policy is given by private insurance carriers and needs to be purchased separately.
Prescription medications will likely get prescribed to you during the dental implant process since it’s considered surgery. You may need to take antibiotics or other medications based on your health and specific circumstances. Most private Medicare Part D prescription plans will cover the necessary medications you need.
How Do I Get Dental Implants?
You need to first find a dentist or oral surgeon that’s in your insurance policy’s network. We recommend scheduling a consultation with them to discuss your oral health concerns. They’ll provide you with a tailored plan that’s designed to restore your health and smile.
If they recommend dental implants are part of your care plan, you should then contact your insurance company to verify how much they’ll cover. Their dental office staff can also work with you to get in touch with your insurer to find out their coverage information.
What Dental Services Does Medicare Advantage Cover?
There may be some aspects of your dental implant procedure that your insurance policy may cover. These services will differ depending on the plan you have. Some of the dental services they could cover include:
- Oral evaluations
- Cleanings
- X-rays
- Fillings
- Crowns
- Dentures
Are Dental Implants Worth the Cost?
As we’ve talked about, you may have to pay some of the cost of your dental implants out of your pocket. Dental implants are a significant investment that can last a lifetime.
This procedure can provide you with countless benefits, including:
- Looking and feeling like natural teeth
- Designed to last for as long as you take care of them
- Eat and chew with ease
- Prevent bone loss
Dental implants are easier to take care of instead of other tooth restoration methods. Patients can brush and floss just like they would with their natural teeth.
Get Help Finding the Best Dental Insurance for Dental Implants
We hope we’ve answered the question “Which Medicare Advantage plans cover dental implants?” Many factors can affect whether your plan will cover your implants. It’s important to work with an experienced insurance agent to make sure you choose the right plan.
At Smart Insurance Agents, we understand it can be challenging to navigate Medicare benefits. Our team specializes in health and dental insurance, ensuring we can get you matched up with the best option possible. Contact us today to get started on your free quote.
