Does Medicare Pay for Implants for Seniors?

Dental implants can greatly improve seniors’ quality of life. However, the high cost often deters seniors from getting implants. This leads many to wonder – does Medicare pay for implants for seniors?

Unfortunately, original Medicare does not cover routine dental care, including implants. However, seniors have options to get coverage for implants through Medicare Advantage plans or stand-alone dental insurance.

In this comprehensive guide, we’ll cover everything you need to know about:

• What are dental implants?
• Benefits of implants for seniors
• Cost of dental implants
• Does Medicare cover implants?
• Medicare Advantage plans with implant coverage
• Standalone dental insurance
• Alternatives if you can’t get coverage
• FAQs about Medicare and dental implants

What Are Dental Implants?

Dental implants are artificial tooth roots used to support dental prosthetics like crowns, bridges, or dentures. They are made of titanium and surgically placed into the jawbone.

The implant fuses with the natural bone through a process called osseointegration. This creates a sturdy foundation to securely hold replacement teeth.

Implants can be used to replace:

• A single missing tooth
• Multiple missing teeth
• All teeth (full mouth reconstruction)

The most common type of implant is the endosteal implant. It is surgically inserted into the jawbone. It looks like a small screw.

There are also subperiosteal implants placed on top of the jawbone, and zygomatic implants anchored in the cheekbone.

Benefits of Dental Implants for Seniors

There are many reasons dental implants are a popular choice among seniors:

Improved Nutrition

Ill-fitting dentures can make it difficult to chew food properly. This may lead seniors to avoid hard, crunchy foods that are important for nutrition. Dental implants allow seniors to comfortably eat a wider variety of healthy foods.

Prevent Bone Loss

Tooth loss can cause the jawbone to deteriorate over time. Dental implants fuse with the bone, preventing resorption.

Confident Smile

Unlike removable dentures that can slip around, dental implants are permanently fixed. Seniors no longer have to worry about their teeth becoming loose or falling out. This allows them to speak, eat, laugh, and smile with confidence.

Better Oral Health

Implants do not decay like natural teeth. With proper hygiene, they can last decades. Implants also do not rely on neighboring teeth for support. This prevents unnecessary grinding down of healthy teeth to support bridges.

Improved Quality of Life

Studies show dental implants provide physical, social, and psychological benefits. Seniors report improvements in their appearance, speech, comfort, self-esteem, and social interactions after getting implants.

Cost of Dental Implants

The cost of dental implants depends on how many implants you need and which dental professional you see.

According to the American Dental Association, a single implant typically costs between $3,000 – $4,500. The process involves multiple steps over several months.

Here is a breakdown of common implant costs:

• Initial consultation and imaging: $200 – $500
• Tooth extraction: $150 – $650 per tooth
• Implant surgery: $1,500 – $2,500 per implant
• Abutment placement: $500 – $1,500 per implant
• Crown fabrication and placement: $500 – $3,000 per crown

For a complete single tooth replacement, your total costs can range from $3,000 – $5,000. If you need multiple implants or full mouth reconstruction, total costs can exceed $40,000.

Various factors affect the price, such as your location, dental office fees, and complexity of your case. Talk to your dentist to get an accurate quote tailored to your specific needs.

Does Medicare Cover Dental Implants?

Unfortunately, original Medicare does not cover routine dental care or implants. Medicare Part A hospital insurance and Part B medical insurance only cover dental services that are integral to certain covered medical procedures.

Examples include oral exams prior to kidney transplants or tooth extractions before heart valve replacements.

However, you have options to get implants covered through Medicare Advantage plans or stand-alone dental insurance.

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurers. They bundle Medicare Part A and Part B benefits into a single plan. Most plans also include prescription drug coverage (Part D).

Some Medicare Advantage plans offer preventive dental benefits like cleanings and exams. Around 30% of plans also include comprehensive dental coverage for basic and major services like fillings, crowns, and implants.

These dental benefits are optional add-ons called “riders.” You pay an extra monthly premium for the dental rider. Costs vary by plan but are usually between $12 – $50 per month.

If implants are covered, you’ll still have copays or coinsurance. This can range from 30% – 50% of the total implant cost.

Before enrolling, carefully review the plan’s benefits summary. Make sure implants are specifically covered and you understand any limitations.

For example, some plans only cover 1-2 implants per year or have a total annual benefit maximum. Others exclude implant-supported dentures.

Standalone Dental Insurance

You can enroll in individual dental insurance outside of Medicare. For seniors, this includes:

• Employer Group Plans: Get coverage through a spouse’s employer plan. Retirees may also keep their dental insurance.

• Marketplace Plans: Individual dental plans from private insurers purchased on the Health Insurance Marketplace.

• Individual Commercial Plans: Plans bought directly through a dental insurance provider.

• Discount Dental Plans: Join a discount plan for access to dentists in the network at pre-negotiated rates. This is not insurance but can reduce out-of-pocket costs.

Like Medicare Advantage riders, standalone plans have premiums, deductibles, and copays for implants. The costs depend on the plan type, benefits, and insurer. Discount plans provide 10% – 60% off implant treatment.

Paying Out-of-Pocket

If insurance coverage is not an affordable option, some payment strategies can help lower your out-of-pocket costs:

• Dental savings plans
• Payment plans with your dentist
• Medical credit cards or personal loans
• Crowdfunding

Talk to your dental office about available payment assistance plans. Some practices offer their own financing options.

Medicare Advantage Plans With Dental Implant Coverage

Below are examples of popular Medicare Advantage plans that cover implants for 2023:

AARP Medicare Advantage Plan 1

• $28/month dental rider
• 50% coinsurance for implants
• $500 – $1,500 annual benefit limit

HumanaChoice PPO

• $39/month dental rider
• 50% coinsurance for implants
• No annual dollar limit

BCBS Medicare Advantage Dental Plan

• $38/month dental rider
• 40% coinsurance for implants
• $2,500 annual benefit limit

Aetna Medicare Plan

• $33/month dental rider
• $0 copay for 1 implant per year
• Additional implants 50% coinsurance

Cigna Dental 1000 Plan

• $39/month dental rider
• $1,000 annual benefit limit
• $0 copay for 1 implant per year

Compare all available plans in your area to find one that best fits your budget and needs.

Standalone Dental Insurance With Implant Coverage

Here are some examples of standalone dental insurance plans that include implant coverage:

Aetna Dental PPO Plan

• $60 monthly premium
• $50 deductible
• 50% coinsurance for implants
• $1,500 annual limit

Delta Dental PPO Plus Premier Plan

• $54 monthly premium
• $50 deductible
• 60% coinsurance for implants
• $2,000 annual limit

Cigna Dental 1500 Plan

• $38 monthly premium
• $100 deductible
• 65% coinsurance for implants
• $1,500 annual limit

Humana Preferred Plan

• $30 monthly premium
• $50 deductible
• 50% coinsurance for implants
• $1,000 annual limit

DentalPlans.com Access Plan

• $79 annual fee
• 15% – 60% discounts on implants
• No annual limit

Compare dental plans from different insurance providers. Look for the right balance of premiums, deductibles, and coverage that fits your budget.

What If Medicare Won’t Cover My Dental Implants?

If Medicare and dental insurance are not affordable options for you, here are some alternate solutions to get implants:

1. State Programs

Some state Medicaid programs offer limited emergency dental services to seniors under special circumstances