If you are wondering which Medicare Advantage plans cover dental implants, you may want to break down the problem by treatment steps.
First, Medicare is primarily health insurance that covers medically necessary oral care. Therefore, all Advantage plans might pay for specific early-stage procedures.
Second, the optional dental riders you can purchase might also pay for some early treatments that prepare your jaw and gums – even if they exclude coverage for implants.
Third, several companies promote Advantage plans that cover implants but offer them in select regions. Therefore, you have to verify before you buy.
Medicare Advantage Covering Early Dental Implant Steps
Finding a Medicare Advantage Plan (Part C) that covers the early-stage dental implant treatment steps is often easier because these procedures have broad applications.
Dental implant costs for seniors on Medicare are typically the lowest when you can get your plan to pay for these beginning phases. Advantage plans have two components that might honor claims.
- Dental element addressing oral care. Getting insurance to pay for tooth implants means that plan explicitly lists the specific procedure step as a covered benefit.
- Medical element mirroring Parts A & B. Getting the health insurance component to cover tooth implants means demonstrating that the procedure is medically necessary: treating a disease, condition, illness, or injury.
Medicare Advantage plans will sometimes cover diagnostic imaging under the two components (health and dental). The prosthodontist uses the pictures to measure the height and width of your jawbone so they can place the appropriately sized tooth implant and avoid nerves and sinuses.
- A medically necessary Panoramic Radiograph or CT scan might rule out oral cancer and help reposition a broken jaw.
- The dental component might pay for a Panoramic Radiograph once every three years while never covering a CT scan.
Self-help with dental implants is the best way to lower your costs. Find ways to get insurance to pay for as many services as possible.
Medicare Advantage plans will often cover the extractions under both elements. The prosthodontist then uses dental implants to replace those damaged or diseased teeth.
- Medically necessary tooth extractions include the removal of teeth after a non-biting accident or before radiation therapy for head and neck cancer.
- The dental insurance element typically covers tooth extractions made necessary by decay or periodontal disease.
Affordable dental implant payment plans hinge on a simple concept you will learn after your extraction. You need time to heal before each subsequent treatment step, giving you extra time to fund smaller installments.
- Alveoloplasty or bone grafting
- Surgical insertion of the implant body
- Surgical placement of the abutment
A Medicare Advantage plan will often cover Alveoloplasty under the two insurance components. With an Alveoloplasty, the prosthodontist reshapes the bone surrounding the tooth after extraction to prepare the area for receiving the dental implant.
- Medically necessary Alveoloplasty involves the removal of bone within a quadrant after radiation therapy or transplant surgery.
- The optional dental coverage might pay for Alveoloplasty once per year for each quadrant.
Medicaid might cover dental implant early treatment steps such as Alveoplasty under the health (nationwide) or oral care (state-by-state) components. Dual eligible seniors double their chances of success.
Most Medicare Advantage plans might cover bone grafting only under the health insurance component. An oral surgeon might perform a bone graft if your jaw is not strong enough to support a dental implant.
- Medically necessary bone grafts might include jaw restoration after non-biting trauma or radiation therapy for cancer.
- The optional dental coverage rarely includes benefits for bone grafting as it falls into the medical category.
Many Medicare Advantage plans might cover prescription drugs, mainly if it includes Part D benefits. For instance, your prosthodontist might utilize medications to manage pain during each dental implant step or prescribe antibiotics to prevent infection afterward.
- The Part D component might include pain management medications during medically necessary procedures (specific extractions, bone grafts, or Alveoloplasty) while covering all treatments for infection.
- The optional dental insurance element might cover pain management with coinsurance for early-stage procedures with broad applications.
- General anesthesia
- Deep sedation
- Nitrous Oxide
- IV sedation
Medicare Advantage Covering Late Dental Implant Steps
Finding Medicare Advantage plans (Part C) that cover the later-stage dental implant treatment steps is more challenging because these procedures have narrow applications.
- Implant Surgery
- Abutment Placement
- Permanent Dentures and Bridges
Less Costly Option
It appears that most Medicare Advantage plans choose not to cover the late-stage dental implant steps because dentures are the least costly alternative to replace missing teeth and restore chewing function.
Dentures for seniors on Medicare are often more affordable when your Advantage plan includes benefits for this tooth replacement alternative. Removable dentures are less expensive than permanent implants, but insurance also helps with costs.
- Discounts from using in-network dentists
- Coinsurance paying 50% of the allowed amount
Even if you can find a Medicare Advantage plan that covers dental implants in your county, it will not help much. The annual maximums are typically very small compared to the cost.
The annual maximum for dental insurance means the plan will stop honoring claims once the amount paid exceeds the limit. Payments resume at the beginning of the following plan year.
The annual maximums that we surveyed range from $1,500 to $2,000 per person. Compare these limits to the average retail costs of dental implants.
- Single tooth: $3,500
- Full mouth replacement: $35,000
We know that some Medicare Advantage plans pay for the late-stage dental implant treatment steps because the issuing companies publish statements indicating this is true – in some cases.
However, they couch these overarching declarations with qualifiers, such as “may include” or “some or all.” Therefore, you must research the benefit listing for each plan offered in your zip code to verify coverage.
A minority of United Healthcare (UHC) Medicare Advantage plans appear to cover dental implants while the majority do not. An article published on the UHC website lists covered procedures with the qualifier “includes some or all of the following.”
However, we only found plans excluding the coveted benefits when sampling UHC offerings in multiple states.
- It does not cover any part of an implant-supported bridge
- Implant crowns are not covered
Research United Healthcare plans online here. For each option, click Plan Details > Dental Coverage > Platinum Dental (PDF) to get a definitive listing of covered procedures.
We found no evidence indicating that Humana Medicare Advantage plans cover dental implants in any state or county. The company website does not address the topic, and we sampled 10 of their 170 + variations and found the following disclosure on all ten.
“Does not include coverage for charges for any type of implant and all related services, including crowns or the prosthetic device attached to it.”
Research the Humana MA Dental plans online here. Scroll down to page five to find the plan numbers supported in your state. Then, scroll back up to page four and click on the corresponding links to get the listing of covered procedures.
It appears that Aetna Medicare Advantage plans will sometimes cover dental implants. They publish an article stating they include the benefits, but with the following disclaimer.
“Some of the covered benefits may include (be sure to check with your plan for details).”
Check the Aetna MA dental plan details online here. However, be prepared for underwhelming specifics. Fortunately, the site includes a handy option to call a licensed agent with a personal code so they can pick up where you left off – and hopefully provide the needed verification.
The Kaiser Permanente Senior Advantage Plus plan covers most later-stage dental implant procedures for members living in at least two states in their service area: California, Colorado, the District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington.
However, do not expect a whopping return on a small $16 monthly premium investment for the combined hearing, vision, and oral care benefits.
- Coinsurance (percent paid by the patient) is 50%.
- The annual benefit limit per calendar year is $1,000.
Enroll in the optional Kaiser Senior Advantage plan online here. However, you may need to perform a Google search for the Evidence of Coverage in your state to confirm if the coveted benefits are included in your region.