Does Medicaid or Medicare Cover Dental Implants?


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FAQ

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!

What others are saying

  1. I agree with that comment, I lost my oldest twin son 29 yrs old a little over 6 years ago an since then I have had a hard time just living, much less thinking about my needs an my health really. So now that I have kind of started doing that it’s a little late for my teeth. They have started slowly falling out one by one an making it very hard to eat almost anything, I also have been having migraines an some ear problems that I think is due to my teeth an gums. I only get $522 dollars a month an I have started paying 2 Bill’s now, I have no car, I only live in a part of the house I live in because of a fire that burned all my belongings an half the house, so i have it blocked off but still have to use the burnt bathroom to shower. The tub is the only thing that didn’t burn back ther. An I’m on SSI an medicaid, So how do they think I can do anything to my teeth?
    When they are effecting my health.

    Reply
  2. After reading these comments, It frustrates me that Medicaid and Medicare doesn’t focus more on the overall well being of the person that’s affected by immediate dental needs and their total medical well being in the long run. It’s a proven scientific fact from decades of medical studies that having a unhealthy mouth can affect other area’s of the body leading to other serious health problems, complications and diseases that can shorting a persons life significantly. Those area’s would be sense organs, joints, spinal segments, vertebrae, main organs, endocrine and organs. A unhealthy mouth can also cause major psychological problems within a person and most times has to be treated with medications and professional counseling.
    So by Medicaid and Medicare eluding the cost of paying for a individual to have good or reasonable dental work done, such as implants for an example rather than partial or full dentures that will give them years of problems or related problems. They’re actually avoiding the underlying cause of other health problems related to dental needs that they will eventually have to pay for in other ways, making their total cost in years be fifty times more than if they had just paid the money to have someone’s dental work done right in the first place. Even if it were to rebuild a persons mouth with a full set of implants could prevent some of the other health conditions I’ve mentioned, especially the psychological effects.
    A healthy mouth is a healthy body. That’s a quote from the American Dental Association. I hope someday Medicaid and Medicare will reconsider what they pay for and what they don’t when it comes to a persons dental needs. It will save them, or should I say “us” that pay into these programs a lot of money. The most important thing is that it will help individuals be healthier and improve their longevity overall.

    Reply
    • Steven

      You could’ve have explained how “we” feel more eloquently. I don’t have a social life because of these dentures. They don’t fit, I feel self conscious and my self esteem is rock bottom. I don’t know what to do or who to go to for advice. Again you did a great review.
      Thank you,

      Sunsearai Farley

      Reply

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