Dental Implants for Seniors on Medicare | Cut Costs 9 Ways

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.

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 Implants

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.

  1. Have a mouthful of problem teeth in need of repair
  2. 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.

Senior Insurance

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 about senior dental insurance that covers implants that impact whether they make treatment more affordable.

  • 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

Medicaid might cover some of the preliminary dental implant work performed by oral surgeons for dual eligible seniors – regardless of the reason. Getting these early-stage procedures free lowers overall costs.

  • CAT Scans
  • Extractions
  • 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.

  1. Supplemental Security Income (SSI) recipients
  2. Qualified Medicare Beneficiary (QMB)
  3. Specified Low-Income Medicare Beneficiary (SLMB)
  4. Qualifying Individual (QI)
  5. Qualified Disabled Working Individual (QDWI)

Financing Programs

Dental implant financing is another way for seniors to lower treatment costs. Yes, you might have to pay interest and origination fees to borrow money, but it enables you to unlock hidden savings that are bigger.

Your tooth implant expenses are tax-deductible (see below) in the year that you pay the dentist, not when you receive treatment. By consolidating your spending into one calendar year, you only have to overcome the 7.5% AGI threshold once for deductible medical and dental expenses.

Plus, your Medicare premiums count towards the total.  

Tax Breaks

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

Dental Implants for Seniors Paid by Medicare

Seniors searching for dental implants paid by Medicare have to solve a two-part riddle if they want to lower costs using this avenue during retirement. Affordability is critical while relying on fixed pension income.  

  1. Medicare oral care coverage varies
    1. Advantage plans (Part C) is broader
    1. Parts A, B, D, and supplements are narrow
  2. Finding providers accepting reimbursement is tricky

Medicare Covering Dental Implants

First, if you want dental implants for seniors paid by Medicaid, pay close attention during open enrollment in November and December. The choices you make then affect whether your plan will cover any treatment steps.

Advantage Plans

Medicare Advantage plans that cover dental implants for seniors could lower some treatment costs. During open enrollment, keep this in mind as you anticipate needs during the following year.

Medicare Advantage plans combine Parts A, B, and D (and sometimes oral care) delivered through a managed care organization (PPO or HMO). You might realize two types of benefits.

  1. Claim payments are subject to an annual maximum ($1,300 average)
  2. Lower prices from in-network providers charging the allowed amount

So, which Medicare Advantage plans cover dental implants? It depends because private companies offer Advantage plans unique to each state and county. You will have to contact a licensed agent who can help you shop around and sign up.

Parts A, B, & D

Original Medicare Parts A, B, & D does not cover dental implants for seniors except a few narrowly defined preliminary steps deemed medically necessary.

  1. Reconstruction of the jaw following an accidental injury
  2. Tooth extractions in preparation for radiation treatment due to cancer

The Centers for Medicare & Medicaid Services (CMS) rules explicitly exclude “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.”

  • Part A (inpatient hospital care)
  • Part B (services and supplies)
  • Part D (prescription drug coverage)

Supplements

Medicare supplements do not cover dental implants because they follow the underwriting rules for Parts A, B & D. A supplement insurance (Medigap) policy can help pay some unreimbursed costs leftover from approved claims.

  • Copayments
  • Coinsurance
  • Deductibles

In other words, the supplements do not extend benefits for oral care as does an Advantage plan. Keep this in mind when shopping around during the annual open enrollment.

Providers Accepting Medicare

Second, you will need to find a local participating provider if you want dental implants for seniors paid by Medicare. Participating offices accept Medicare reimbursement and agree not to charge above the allowed amount.

Local oral surgeons accepting original Medicare will prove easier to find because they perform procedures frequently deemed medically necessary.

  • Reconstruction of the jaw following an accidental injury
  • Tooth extractions in preparation for radiation treatment due to cancer

Clear Choice probably does not accept original Medicare because most of its services fall outside these narrowly-defined parameters. However, if you have an Advantage plan, consult the provider directory to see if Clear Choice participates in the network.