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I’m fed up with my dentures. I thought they would be the best fix, but I’m tired of them slipping, and my dentist recently told me that they don’t prevent jawbone deterioration. I think it’s time to consider a more permanent solution, but I’m afraid of the cost. So I’m wondering, does Medicare cover dental implants?
Fed up with my dentures,
Deborah from Coral Springs, Florida
A National Health and Nutrition Examination Survey found that nearly 1 in 5 adults aged 65 or older has lost all their teeth. But most people 65 or older have lost an average of 12 teeth. So many people are using a full or partial set of dentures.
You’re not alone in feeling fed up with your dentures, especially if they are slipping. Poorly fitted full dentures can cause many problems, including mouth sores. And partial dentures that fit improperly can cause tooth decay, gingivitis, plaque build-up, and loss of supporting teeth. If it’s been a long time since a new set of dentures, you’re at a higher risk of gingivitis, plaque build-up, and loss of supporting teeth.
“If you currently have a Medicare Advantage plan that includes coverage for dentures, you may explore whether some or all of those benefits could be applied to the cost of your dental implants. “
Aside from dental issues, dentures can affect nutrition because you may be more likely to prefer soft chewable foods instead of fresh fruits and vegetables. Difficulty chewing can lead to digestive problems and nutritional deficiencies. You could also experience chronic headaches or ear pain from poorly fitted dentures.
If you’re experiencing any of these issues, there’s no wonder that you’re fed up and eager to research dental implants!
If you received your dentures while enrolled in Medicare, you might know that Original Medicare Part A and Part B do not provide dental coverage. Medicare Supplement plans do not cover dental benefits either. A Medicare Advantage (MA) plan is offered by private insurance companies and provides additional benefits. Among these benefits may be dental coverage, including dental implants.
Medicare Advantage plans that offer dental plan benefits cover the cost of routine dental care such as cleanings, fillings, dentures, and tooth extractions. When searching for a plan that covers dental implants, you’ll want to review the Evidence of Coverage (EOC) document associated with the plan. You may need to search for “dental implants” or “prosthodontics” in the EOC and pay careful attention to the products and services covered.
We found that in the Coral Springs, Florida area, seven Medicare Advantage plans cover dental implants. These include Simply Level, Simply Complete, Simply More, HealthSun MediSun, HealthSun MediSun Extra, HealthSun MediMax, and the Oscar+Memorial+Holycross HMO plan. Each plan has unique terms and coverage for dental implants.
A local licensed agent can help you break down the cost. In addition to the Medicare Advantage plan’s monthly premium, you’ll be responsible for the plan’s copayment or coinsurance until the maximum annual benefit is reached. You would then be responsible for the remaining costs of dental services received during that year.
Because the terminology can be overwhelming and the coverage details so specific, we recommend that you speak with a dentist who routinely works with Medicare Advantage plans and understands the claim codes. They would be most suited to walk you through the cost you may incur for your dental implant procedure.
Also, if you currently have a Medicare Advantage plan that includes coverage for dentures, you may explore whether some or all of those benefits could be applied to the cost of your dental implants.
I hope that this information was helpful and clarified your question on whether Medicare covers dental implants. Medicare can be confusing, and you do not have to handle it alone.
At Connie Health, we help you throughout your Medicare journey. If you need help walking through a plan’s benefits or finding the right one for your needs, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711) for assistance.
Last updated: February 27, 2023
Enrolling in a Medicare Advantage plan is the only way to get routine dental care, including dental implants. Many Medicare Advantage plans offer dental implant coverage, but you should confirm this by reviewing the Evidence of Coverage (EOC) document associated with the plan. You could search for “dental implants” or “prosthodontics” in the EOC and review the products and services covered.
Maybe. Some Aetna Medicare Advantage plans may cover dental, but each plan varies.
To be sure that the plan you’re considering has the dental implant coverage you want, review the plan’s Evidence of Coverage (EOC). Every plan’s EOC is different. Search for “dental implants” or “prosthodontics” in the EOC and review the dental products and services covered.
Yes and No. Some Medicare Advantage plans may cover dental implants, while others won’t.
It’s not universal that Medicare Advantage plans cover dental implants, so check the plan’s Evidence of Coverage (EOC) before enrolling. You can search for “dental implants” or “prosthodontics” in the EOC to review the dental products and services covered.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.