Seniors on Medicare typically pay most dental implant costs themselves.
Medicare rules explicitly exclude “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.”
However, every rule has an exception, and you might find several loopholes.
Seniors with medically necessary reasons sometimes find that Medicare might pay for specific early-stage tooth implant treatment steps such as CAT scans, extractions, and bone grafting.
Meanwhile, people over 65 can still purchase individual insurance and take advantage of IRS rules to lower costs in a meaningful way. Plus, Medicaid might help you out.
Does Medicare Cover Dental Implants?
Medicare does not cover dental implants for seniors unless a treatment step is medically necessary or integral to a covered service. While these situations are rare, they can make a considerable cost difference.
Therefore, patients on fixed retirement income from social security should pay close attention to the legal definition of medically necessary and how it applies to getting health insurance to cover tooth implants.
Medicare Part A (inpatient hospital care) could pay for specific early-stage dental implant procedures. For example, a senior involved in an accident might require medically necessary treatment in a hospital for a broken jaw.
Medicare Part B (services and supplies) might cover select early-stage dental implant procedures connected with a covered illness. For example, a senior might require medically necessary care linked to cancer.
The Centers for Medicare and Medicaid Services (CMS) explicitly includes tooth extractions before radiation treatment for neoplastic diseases involving the jaw.
Medicare Advantage Plans (Part C) might pay for a broader array of early-stage dental implant procedure steps such as CAT Scans, extractions, and bone grafting because they sometimes include oral surgery benefits.
Private companies offer Advantage plans unique to each state, which provide all of your Part A, Part B, and Part D benefits – and could include oral care.
With so many possible designs, consult your Advantage plan document to determine the level of oral care benefits it provides – if any.
Medicare Part D (prescription drug coverage) might cover a small portion of late-stage dental implant costs for seniors. Your oral surgeon or prosthodontist might suggest medications, which the plan could cover – if prescribed by a physician.
- Opioids for pain relief
- Antibiotics to fight infection
- Bisphosphonates for bone stability
Asking whether a local dentist or Clear Choice accepts Medicare or an Advantage plan is unlikely to help seniors find an affordable solution. All providers will gladly take any claims check issued by an insurance company and deposit it into the bank account.
The core issue is not whether Clear Choice takes Medicare. It is whether the government-configured health insurance will cover any aspect of dental implant procedures.
The answer to this crucial question is predominately no – as noted above. Therefore, seniors should look elsewhere for help by asking sharper questions.
Lowering Dental Implant Costs for Seniors
Because seniors on Medicare typically pay for dental implants out-of-pocket, finding ways to lower costs is paramount – especially for those whose fixed retirement income barely covers basic living expenses.
Free dental implants for seniors on Medicare are a long-shot bet that few patients have a realistic chance to win. While some charities provide pro bono services, the demand outstrips the supply by a wide margin.
Lowering out-of-pocket costs is a more reasonable expectation, which you can accomplish by getting selected services free while paying the total price for others.
Dentists often offer steep discounts to patients apt to generate future profits.
- Have a mouthful of problem teeth in need of repair
- Have the financial capacity to pay for extensive work
Elderly patients often meet the first condition (poor oral health) but fall short on the second (financial capacity). Fortunately, insurance, Medicaid, and tax breaks can help.
Dental insurance covering implants and other procedures is one way for seniors over 65 to obtain the financial capacity to pay and lower costs significantly. You can buy coverage with no upper age limit.
However, make sure that you understand several key concepts.
- In-network dentists cannot charge more than the allowed amount, which could save you a bundle over time
- Plans without waiting periods include graded benefits, where the percentage paid grows over time
- Missing tooth exclusions mean that the coverage applies only to teeth extracted after the effective date
Medicaid might cover some of the preliminary dental implant work performed by oral surgeons for dual eligible seniors – regardless of the reason.
- CAT Scans
- Bone grafting
Medicaid sometimes covers dental work for adults, but benefits vary state-by-state. Also, the least expensive treatment rule means that the program never pays for tooth implants regardless of where you live.
Dual-eligible Medicare Medicaid seniors fall into one of five categories.
- Supplemental Security Income (SSI) recipients
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
- Qualified Disabled Working Individual (QDWI)
Dental implants are tax-deductible, meaning the IRS might offer significant discounts to seniors on Medicare with extensive physical and oral health expenses.
However, consolidating expenses into a single year yields the most savings!
Full-mouth restoration pricing starts at $10,000 and ranges higher. The steep price means you could readily exceed the two spending thresholds and lower costs significantly.
- Itemized deductions have to exceed the personal exemption
- Individual: $12,550
- Jointly: $25,100
- Unreimbursed medical and dental expenses must exceed 7.5% of AGI