Author: Tej Seelamsetty

06-02-2022

All that You Need to Know About Dental Implants and Medicare Coverage.

Imagine you're back from a dental checkup, and your dentist has recommended a dental implant. You wonder if Medicare will cover your expenses.

What's a Dental Implant?

A dental implant is the foundation for an artificial tooth implanted into your jawbone. It acts as the root for a replacement tooth.

They usually have a small titanium screw fused to the bone. Once the implant has bonded, a replacement tooth (called a crown) is attached to the implant. (Sometimes, the entire assembly — root and crown together — may be referred to as a "dental implant" or "dental implant system").

If you have a missing tooth, dental implants are the best way to provide a foundation for a replacement tooth that looks, feels, and functions like a natural tooth. They are strong and durable — an ideal option to help restore your smile. They are made of titanium, a metal compatible with the human body.‎

Dental Implant System|Source: FDA

The implant consists of a body and an abutment, with a crown replacing the missing tooth. ‎Your dentist surgically inserts the dental implant body into your jawbone. The abutment is attached to the implant body, and the crown is then fixed to the abutment.

Will I Get Medicare Coverage for My Dental Implants?

Medicare Part A and Part B generally don't cover dental services. Medicare Part A covers inpatient hospital care, and Part B covers outpatient care.

However, some Medicare Advantage plans may cover dental services. If you have a Medicare Advantage plan with dental coverage, check to see if it covers dental implants because many plans cover only basic dental services like annual examinations and cleanups.

Some Medicare Advantage Plans provide dental insurance, which covers complex procedures like tooth extractions, tooth replacements, and dental implants but may also have a maximum benefit limit or copays and coinsurance.

Will Original Medicare or a Medicare Supplement Pay for My Dental Implants?

Original Medicare or a Medicare Supplement covers your Part A and Part B expenses, but sometimes it may cover dental services. 

If your dental procedure is related to an illness or injury, it might get coverage. For example, dental checkups or extractions performed before heart surgery, an organ transplant or cancer treatment might be covered by Medicare.

Similarly, you might get coverage if you need a dental implant because you lost a tooth due to an accident.

In addition, if you need to undergo a dental implant surgery in a hospital due to a health condition, Medicare might pay for the hospital stay. You must have Medicare Part A and be admitted to the hospital as an inpatient to have a chance to get coverage. Also, if any complications arise during the process, Medicare may provide coverage for the hospital services.

Will I Get My Dental Medications Covered?

Medicare Part A and Part B don't cover prescription drugs, but if your dental implant procedure is performed in a hospital, your Part A Medicare generally covers the medications prescribed during your hospital stay.

If it's an outpatient procedure, you might get coverage for your medications if you have a separate Prescription Drug Plan (Part D) or a Medicare Advantage Plan that includes prescription drugs.

Your doctor may prescribe medications like antibiotics, painkillers, etc., before and after your surgery. Check to make sure your Medicare plan covers the drugs prescribed by your doctor.

You can review the Summary of Benefits and the Evidence of Coverage (EOC) provided by your plan to learn more about your coverage eligibility.

In the Summary of Benefits, consumers can learn about a health plan's costs, benefits, covered health care services, and other features. 

The Evidence of Coverage (EOC) is a document that explains all of the details of your Medicare Advantage or Part D plan. The EOC includes information about what services and drugs are covered by your plan, how much you'll pay for covered services, and what rules you'll need to follow.

Takeaway

Each Medicare Advantage and Prescription Drug Plan is different and offers different levels of coverage. Check your plan's coverage eligibility by reviewing its Evidence of Coverage.

Medicare claims can sometimes be confusing, especially when related to special services like dental surgery.

Fair Square Medicare exists to help you understand Medicare. We're always available to answer your queries. You can speak to our licensed experts by dialing 1-888-376-2028, and they'll help you figure out how your dental coverage works and what it covers.