Dental Implants and Medicare

August 4, 2022 | John Demko

Dental care is essential to our overall health. When considering having dental work or dental implants done, remember first to check what dental coverage your current insurance provides.

Original Medicare (Parts A and B) does not cover most dental procedures. It will only cover dental expenses that are part of medical treatment related to surgery, illness, or injury. For example, if you are required to have a dental exam before surgery, Original Medicare may cover that expense. If you need dental work because of an injury to your face or jaw, Original Medicare may also cover those costs.

Any other type of dental work will require you to have dental insurance. Dental coverage might be built into your plan if you purchased a Medicare Advantage Plan. If you purchased a Medicare Supplement, you would need to purchase a separate dental insurance policy.

Know Your Coverage

When considering having dental work done, read the Explanation of Benefits (EOB) for your plan or call your insurance company. This will help you understand which procedures are covered and what your percentage of the costs will be.

Ask about how pre-existing conditions are covered. For example, if you had a missing tooth before enrolling in the plan, some plans exclude treatment or have a waiting period before the plan will cover treatment. Each insurance company and each plan can be different. Always ask about any exclusions or waiting periods so non-covered expenses don’t catch you off guard.  

Instead of providing dental insurance, some Medicare plans may give you an allowance of money to be used towards dental expenses. You can use the allowance towards ANY dental expense, thereby removing the barrier of exclusions or waiting periods.

Next, check if your plan uses a network of dentists. To get the best prices, use one of the in-network dental providers. Some plans allow you to go to out-of-network dentists, but then also allow those dentists to charge you higher prices.  

Also, check if your dental insurance pays the dentist directly or if you must pay the dentist and submit a claim to insurance for reimbursement. If you need to file a claim, keep copies of your dental bills and receipts until your reimbursement is processed.  

Finally, identify your plan’s maximum benefit amount. That is the most your plan will pay towards covered services. Dental implants can be expensive, ranging between $3,000 and $5,000 dollars. Your plan will only contribute up to a certain amount towards those costs. You will need to prepare how to pay the remaining amount you are responsible for.

Switching Coverage

If you are considering switching to a different Medicare plan, for example during the Annual Enrollment Period in the fall, these details about dental coverage are important to keep in mind. Maybe you have been okay with a plan that only covers routine cleanings and exams, but now you need a crown. Switching plans can provide you with new or additional coverage.

If you have a Medicare Advantage Plan, you can use the Annual Enrollment Period (AEP) from October 15 – December 7 to enroll in a new plan for the following year. In addition, there is Open Enrollment from January 1 – March 31, when you can change between Advantage plans.

Finally, if an insurance carrier has a 5 Star Rating, that allows you to switch into the plan at any time during the year. Be sure to check that the new plan has both the level of dental coverage that you need as well as still covering your medical and prescription drug needs. The same is true if you purchase dental insurance separately from your health insurance. 

Check all the details of coverage amounts, exclusions, and waiting periods to make sure the plan works for you. 

Lead With a Smile

Having the right level of dental coverage means that you get both the routine care and the comprehensive dental care that you need. If you have any questions about how your current plan works or want to look at what other options are available, call Twin City Underwriters at 651-488-0172. We want to help you lead with your best smile!