Does Medicaid or Medicare Cover Dental Implants?

In This Guide

Does Medicaid Cover Dental Implants?

If you are under 21 and Medicaid-eligible, you are required to receive the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit. The main purpose of this benefit is to prevent and provide early diagnosis and treatment of medical conditions, including dental services. If you need implants to replace permanent teeth, Medicaid may cover the cost of this treatment.

However, it’s unlikely that this kind of coverage will be provided as dental implants and other implant-supported options are regarded as an elective treatments. Medicaid is designed to cover basic treatments such as tooth extractions and their replacement with partial or full dentures.

It is rare for Medicaid to cover the cost of a fixed bridge and even less likely that it would ever cover the cost of a dental implant. Not unlike many dental insurance companies, Medicaid takes the view that only the least expensive alternative treatment will be covered, rather than the best possible treatment.

About Medicaid

Medicaid was set up to provide essential medical services for people with low incomes. It will often completely cover the cost of these services. The program is funded by state governments and by the federal government but is managed by the states.

Every state has to follow the basic guidelines for Medicaid, but individual states are able to set eligibility guidelines as to which healthcare services will be covered. This means they can determine whether or not to provide dental care coverage for Medicaid recipients who are over the age of 21. If they do provide dental coverage then they can decide whether this will include implants.

States that Cover Dental Implants Through Medicaid

Does Medicare Cover Dental Implants?

If you are covered under the Original Medicare (Part A & B) then, unfortunately, you will not have coverage for the majority of dental services. This includes routine dental care and examinations, as well as cleanings, tooth fillings, extractions and implants.

Dental coverage under Medicare is extremely limited and the only way they might consider paying for dental implants is as part of a full mouth reconstruction. A patient might require this kind of treatment if there has been significant damage to the tissue or jawbone as a result of an injury or disease.

Most routine dental care isn’t covered by Original Medicare. The only dental services that are covered by Original Medicare are those that are deemed to be an essential part of another Medicare covered procedure.

For example, if you require heart valve replacement surgery or a kidney transplant, you may be covered for a dental exam before surgery, as it is considered essential to confirm that you don’t have any dental diseases that could affect the outcome of the procedure.

All Medicare Advantage plans will include at least the same benefits as Medicare Part A and Part B. Some of these Advantage plans include benefits not covered by Original Medicare such as routine dental care and optical benefits. These additional benefits depend on the individual plan.

About Medicare Part A and Part B

Medicare Part A is a hospital insurance plan and people who are eligible can enroll free of charge. However, anyone who doesn’t have Social Security coverage will need to pay a portion of the premium. Anybody who applies for Social Security is also automatically applied for Medicare, but anybody applying for Medicare isn’t automatically assumed to be applying for Social Security.

Medicare Part B is an insurance program that will cover medical costs from doctors, outpatient providers, and surgeons, as well as medical supplies fees. Anybody who is eligible for Medicare Part A is able to select supplemental Part B coverage.

In order to benefit from Medicare Part B, a monthly premium must be paid. It’s generally the case that anybody who obtains routine care provided by out-of-network providers will not be covered by Medicare or by a Medicare Advantage HMO plan for the costs.

You become eligible for Medicare at age 65, but you don’t have to wait to retire in order to enroll in this program. Anybody who applies for Medicare is eligible for both part A & B. It’s worth signing up for Medicare Part A even if your intention is to continue working after age 65.

If your union or employer provides health coverage, signing up for Part A may still help to cover some of the expenses not covered by a group health plan.

What to Read Next

Over to You

We’re interested to know – are you eligible for either Medicaid or Medicare and what dental treatment you looking to get? Let us know by leaving a comment below!

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4 thoughts on “Does Medicaid or Medicare Cover Dental Implants?

  1. I am a 69 year old unmarried woman. A medical trauma left me with 9 titanium rods around my spine AND big medical bills that wiped me out financially. I have heart problems and epilepsy. I have been conscious of good dental health all my life UNTIL I suddenly had zero money for dentistry. After 10 years without dental care I have had to have all of my back teeth extracted. I have to chew with my front teeth. I also have substantial gum disease. The only insurance I have is Medicare and Medicaid. I AM HEARTBROKEN and ashamed. I cry every day, praying for some way to earn the money it takes for implants. I didn’t ever think I would die alone – I am a pretty woman except for my teeth. I dreamed of finding a partner with whom to share life. Now, it’s just not going to happen. Is there ANY way to find implant help in my circumstance?

    • I’m so sorry to hear about your situation. Please don’t cry, it’s making me cry. I am in the same position. I’m really struggling financially and can’t find a job despite my master’s degree in business. I think rather than implants you should just get dentures, they would be much much cheaper than implants which will cost tens of thousands of dollars. Search online for information…maybe there’s a non-profit in your area who helps pple in your type of situation. Please keep your head up.

    • Barbara,
      I was doing some research last night and wanted to share it with you. Contact dental schools in your area. They will do work on you at a reduced cost in exchange for you allowing their student-dentists to do work on you. Of course they’re supervised by a “real” dentist. Secondly I came across numerous locations providing dental work to patients over 60 and/or who are of low income in my area. Google for some in your area. I was really surprised at the number of clinics I found. Best luck, please dry your eyes.

  2. I am a 55 year old school teacher living in Meridian, Ms. I have Delta Dental but it only pays $1,200 a year. I’ve always had bath teeth, my mother did too. I took part of my retirement out five years ago and got veneers on the top and they are decaying underneath and causing me embarrassment. I have 6 teeth on the bottom. I am looking for any help I might qualify for but unsure what’s available to be besides my work dental plan. My teeth have been a source of shame my whole life but I’m not rich. Can y’all help?

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