Does Medicare Advantage cover dental implants?

Does Medicare Advantage cover dental implants? Like most health insurance plans dental procedures are not part of Original Medicare, but it can be one of the additional benefits of opting for a Medicare Advantage plan. Some Medicare plans include just routine dental care treatment, including cleanings. Others may have more comprehensive coverage.

If you’re looking for a Medicare Advantage plan that covers dental implants, shop around. Enter your ZIP code now to compare Medicare Advantage quotes that include dental coverage.

Does Medicare Advantage include dental benefits?

Many Medicare Advantage plans include some level of dental benefits. Some plans only offer routine care coverage, which includes things like cleaning, dental exams, and x-rays. Other dental insurance plans may include extended dental treatment, like fillings, crowns, and even dental implant procedures in some cases.  Some states have elected to offer dental care, while others have not.

According to Medicare.gov, there are no coverage options at all with Original Medicare for dental services. That means choosing a Medicare Advantage plan is the only way to get your visit to the dentist covered. Because Medicare Advantage is provided by private insurance companies, they can determine what level of coverage to offer for dental services, or whether to offer it at all.

How are dental implants covered by Medicare Advantage?

Dental implants are considered major restorative dental work. This means that a plan that only includes routine care won’t cover them. It may take a little digging to find a plan that does include coverage for this type of service. In some cases, the coverage may be offered by a partner company that specializes in dental insurance.

If your tooth was lost due to an injury or accident, or if the tooth loss is causing additional medical issues, your insurance may be more likely to cover some fees.

What is the cost of dental implant coverage on Medicare Advantage?

Some plans may offer major dental coverage as an add-on for an additional premium. It may be more difficult to find this level of coverage in a basic $0-premium Medicare Advantage plan, but it’s possible.

Estimates for the total cost of a single implant which includes the implant, the abutment and the crown, or replacement tooth could range from $3,200 to $6,000, according to the American Dental Association Health Policy Institute’s Survey of Dental Fees.

Most plans will have some level of coinsurance and possibly also a deductible for major restorative dental work like implants. There will also likely be a yearly cap on what the plan will pay out. You should ask ahead of time what your out-of-pocket expenses are expected to be.

How do I know if my Medicare Advantage plan covers dental implants?

If you currently have Medicare Advantage and aren’t sure what’s covered for dental services, you can log into the company site to check your benefits. You can also call your Medicare Advantage provider to ask whether or not dental implants are covered. Be sure to ask about out-of-pocket costs.

If you don’t have the coverage, you may be able to add it during open enrollment, or you may want to consider switching plans at the same time.

Does my dentist accept Medicare Advantage dental insurance?

Most plans have a network of care from which you will need to select your dentist in order to use your insurance. Call your dentist to find out if they accept your Medicare insurance, or check with the provider network for the insurance company.

You may have to switch to a new dentist to use your coverage if the current dentist is out of network. This is especially common if you use an HMO (Health Maintenance Organization) for your insurance.

Is dental insurance for implants different from full dental coverage?

The short answer here is no. Dental insurance plans vary based on their state and the type of treatments they cover. Full coverage plans mean they cover preventive care, like cleanings, fluoride treatments, and X-rays; basic care, like fillings and extractions; and major services, like bridges, crowns, dentures, and dental implants, among other treatments.

For an example, see our Aetna Dental Insurance Review for details.

Case Studies: Analyzing Medicare Advantage Coverage for Dental Implants

Case Study 1: “Ms. Johnson’s Experience With Medicare Advantage and Dental Implants”

Ms. Johnson is a 67-year-old retiree who recently enrolled in a Medicare Advantage plan. She has been experiencing issues with her teeth and requires dental implants to improve her oral health and quality of life.

Ms. Johnson contacts her Medicare Advantage plan provider to inquire about coverage for dental implants. She learns that original Medicare does not cover dental implants, but some Medicare Advantage plans offer additional benefits that may include dental coverage.

Fortunately, Ms. Johnson’s Medicare Advantage plan includes dental coverage, which extends to dental implants. She undergoes a comprehensive dental evaluation and meets the plan’s criteria for implant coverage. As a result, her plan covers a portion of the cost of dental implants, reducing her out-of-pocket expenses and allowing her to receive the treatment she needs.

Case Study 2: “Mr. Smith’s Medicare Advantage Plan and Limited Dental Coverage”

Mr. Smith, a 73-year-old Medicare Advantage plan member, requires dental implants due to significant tooth loss caused by aging and dental decay. However, he is unsure if his plan offers coverage for dental implants.

Mr. Smith contacts his Medicare Advantage plan provider and learns that his specific plan includes dental coverage. However, upon reviewing the plan details, he discovers that dental implants are classified as an elective procedure and are not covered under his plan.

Unfortunately, Mr. Smith’s Medicare Advantage plan does not cover dental implants. As a result, he would be responsible for the full cost of the procedure. Mr. Smith explores other options, such as dental discount plans or standalone dental insurance, to help reduce the financial burden associated with dental implants.

Case Study 3: “Mrs. Martinez’s Medicare Advantage Plan With Dental Implant Waiting Period”

Mrs. Martinez, a 70-year-old Medicare Advantage plan member, requires dental implants due to tooth loss resulting from an accident. She is curious to know if her plan provides coverage for this treatment.

Mrs. Martinez contacts her Medicare Advantage plan provider and discovers that her plan offers dental coverage, including dental implants. However, there is a waiting period of six months before she becomes eligible for dental implant coverage. The waiting period is in place to ensure that members do not enroll in the plan solely for major dental procedures.

Mrs. Martinez’s Medicare Advantage plan eventually covers dental implants, but she needs to wait for six months before becoming eligible for the coverage. During this waiting period, she works closely with her dentist to explore temporary solutions and manage her oral health.

After the waiting period expires, her plan covers a portion of the dental implant costs, allowing her to proceed with the necessary treatment.

Does Medicare Advantage cover dental implants? The Bottom Line

Whether your Medicare Advantage plan covers dental implants depends on the plan you selected. To find out which Medicare Advantage companies offer coverage for dental implants, you will need to take a look at some plans available to you and compare them on rates and coverage.

Dental implants are usually considered to be cosmetic procedures that are not essential to the health and well-being of covered individuals.

To get started looking for a Medicare Advantage plan that covers dental implants today enter your ZIP code below.