Insurance and Medicare coverage

Original Medicare

Medicare.gov states that in most cases Medicare does not cover dental services such as cleanings, fillings and extractions, or items such as dentures and implants.¹ Patients pay all costs for non-covered dental services in most cases.¹

When Medicare may pay for dental care

Medicare may cover some dental services that are directly tied to other covered medical treatment.¹ Examples listed by Medicare.gov include:¹

• Dental care before an organ transplant or heart valve replacement.
• Tooth extraction to treat a mouth infection before cancer treatment.
• Dental exams before kidney dialysis for end-stage renal disease.
• Treatment of complications during head and neck cancer treatment.

Private dental plans

The ACP states that patients may qualify for some insurance coverage for implants, and that situations vary.² The AAID states that an increasing number of insurance companies provide some coverage.³

Comparing options

The ACP states that replacing a single tooth with an implant costs almost the same as replacing it with a regular fixed bridge.² The ACP adds that cost varies by patient needs, bone quantity and region.² The AAID states that bridges and dentures may need replacement as often as every 5 to 15 years.³

Financing

The AAID states that many implant dentists offer financing and payment options.³

Questions to ask the plan

• Is implant placement covered, or only the crown or denture on top.
• Is there an annual maximum, and does it reset each calendar year.
• Is there a waiting period or a missing-tooth clause.
• Is a pre-treatment estimate available.

Questions to ask the office

• Will the office submit a pre-treatment estimate to the plan.
• Which parts of treatment are billed separately.

General information about dental implants and coverage. Coverage decisions are made by the plan.

Sources

1. Medicare.gov: Dental Services Coverage. medicare.gov
2. American College of Prosthodontists (GoToAPro): Dental Implants FAQ. gotoapro.org
3. American Academy of Implant Dentistry: Value and Cost. aaid-implant.org