By age 74, about one in four adults have lost all of their permanent teeth. When a permanent tooth falls out or must be extracted due to injury or decay, a dentist typically recommends replacing it with a dental implant. While traditional Medicare does not cover most basic or prosthodontic care such as dental implants, some Medicare Advantage plans may provide help paying for this service.
Original Medicare (Medicare Parts A and B) does not provide dental benefits except under extremely limited circumstances. Fortunately, some Medicare Advantage (Medicare Part C) plans come with options for covering basic and major dental services. About 53% of Medicare Advantage beneficiaries had access to preventive and extensive dental benefits such as dental implants in 2019.
As private insurers, Medicare Advantage plan providers can offer an array of benefits beyond the minimum requirements of Medicare Parts A and B. They may charge additional premiums for extras such as dental care. The companies might also use bonus payments or rebate dollars to help cover the cost of such supplemental benefits.
Plans that offer extensive dental coverage typically charge an extra premium. Dental premiums are in addition to the Medicare Part B premium and other Part C benefits. In 2019, these costs ranged from about $108 annually to over $692 annually.
Some Medicare Advantage plans utilize a cost-sharing approach to covering dental benefits such as dental implants. Some plans may cover most of the cost while others require flat co-pays. Others charge a flat coinsurance rate of 20% to 70% for any extensive dental service.
Medicare Advantage plans with extensive dental benefits typically cap the total amount provided. Most plans have limits of about $1,000. Plans usually limit the number of services covered as well.
In some cases, seniors covered by both Medicaid and Medicare can access dental benefits through Medicare Advantage plans. However, it can be quite complicated to determine which coverage options pay for certain services. Any additional premiums or cost-sharing expenses would be a significant factor as well.
Plans vary widely, so careful research is essential to understand the availability and extent of coverage for dental implants. Kaiser Permanente‘s Senior Advantage Plus plan includes basic and major restorative dental services. After meeting a $50 dental deductible, enrollees pay 50% coinsurance up to a $1,250 annual benefit maximum.
Medicare Advantage plans give enrollees an Evidence of Coverage notice, which specifies whether they pay for dental implants. This notice will also discuss how much beneficiaries will have to pay on their own for prosthodontic services.
Seniors can consult the Medicare Plan Finder, type in their ZIP code and look for Medicare Advantage plans. Next, they can select a plan’s title and click on its “Benefits” tab. Plans with dental coverage show colored circles with a D; a list of network dental providers should be available. Seniors can also ask their dental office which plans are accepted there.
Many seniors who need dental implants can expect to pay significantly for prosthodontic services, in addition to premiums, coinsurance, copays, annual caps and other out-of-pocket costs required by their Medicare Advantage plan. They may want to consider purchasing a stand-alone dental insurance or discount plan if that is financially feasible. Veterans and other populations may be eligible for free or low-cost dental implants through various charities and programs.
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