In This Guide
- Does Medicaid Cover Dental Implants?
- About Medicaid
- Does Medicare Cover Dental Implants?
- About Medicare Part A and Part B
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.
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
- How to Get Low Cost Dental Implants
- Dental Implant Insurance vs. Dental Plans – Which is Best?
- How a Dental Discount Plan Can Save You $3300 on Implants
- Dental Bridges vs Implants: Comparison of Costs & Benefits
- Dentures vs Dental Implants – Costs & Benefits
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
About dental implants vs dentures – especially Steven Hlinka’s comments – Very nicely and succinctly said. I am having a heck of a horrible time navigating the medicare/Medi-Cal – government dental programs. And the lessons come at a very high cost to me – meaning that by the time I figured out that they were not going to put ANYTHING into the huge hole left in my jaw from a tooth extraction I allowed them to do, the teeth next to the extraction site were failing, getting loose and falling out too. Had I known that prior to allowing the extraction, I would have waited until I could find a way to get the money together to backfill that huge hole. Also, they – Medi-Cal, approved a root canal and then declined any type of crown or protection to be covered to protect that root canal and now….that tooth has to be extracted too! Nevermind the horrible experience of having to go through a root canal for apparently no good reason. So now I have extractions that are leading to more missing teeth and they refuse to approve anything at all for any of it. I get the feeling that they want all of my teeth to fall out so they can just do the denture thing. Thing is that I cannot have any dental device that is removable due to extreme and severe thrush in my mouth. It would be sheer misery every single day of my life. I am trying to find a way to refinance my home or try to get an equity home loan just to finance the work I need done on my teeth. And it has and will continue to cause havoc with my existing health problems and no doubt, cause some new ones. I don’t see how this is a win situaton for the government programs or for me. Pay now or pay later or at least help me some how. I just keep praying on it because I don’t see a solution at all. I am at a total loss and basically, no one cares. Not medicare, not Medi-Cal, not social security. No one. It is depressing and hopeless. Makes me think maybe it is just my time to exit this world – all because I do not want to go through all the pain and suffering coming my way because of these problems that they have not worked out solutions for. I have a State Hearing tomorrow for it, but I already know what is going to happen. I just have to do the footwork to the best of my ability and rest in the knowledge that I did everything I could. I even applied to Donated Dental, but they were not accepting any applications due to having too many to deal with already. I am out of suggestions and out of ideas. Seems like a sad way to spend my last years on this earth. I certainly won’t be going anywhere in public with my mouth like this. It’s horrible.
Please think about this!! I am diabetic and have had dentures for about 20 years. Like Medicade’s forum states….dentures every “8” years (changed from 5) even if they are lost, stolen, or broke. The sad thing is you can not have any pride of self worth because of the sore mouth from broken dentures, or eating things that either cut, bruise, or put blisters on your gums.
What does that cause in addition? You can’t chew your food properly and can’t eat a lot of the healthy foods you need to eat (in my case) for diabetes, digestive issues, CHF, and obesity as well as MANY other health issues.
On the flip side of that, I would not like being hit by someone, falling, or in a car accident, and maybe getting hit with the air bag. What kind of damage could that cause to your jaw bones? Splintered bones, or shattered bones in your face.
Personally I would be content with the implants on the bottom and fine with a denture on top.
At the end of the day, it couldn’t cost as much as having to pay Emergency calls with any of the mentioned things that could happen. Then add all the surgeries to repair or treat other medical problems caused from being denied implants.
With all that being said, I know I am pretty much home bound because of how bad I feel about my appearance. I fully believe you feel as GOOD as you look. But can’t get over the depression from all of it!
I can certainly relate to how missing teeth can affect your life and health. I am 65 years old, I have had 2 sets of dentures in my life but they either hurt my gums, the bite wasn’t right or the teeth were actually too big. I am losing weight as not being able to eat (chew) my food properly, stomach stays upset and now, no appetite at all. I am losing way too much weight as a result. Also, what I would give to just be able to smile without covering my mouth! Also suffering with other ailments that until now I didn’t realize that could be a result of missing teeth. What I wouldn’t give to have implants.
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.
I believe I am eligible for both Medicare and Medicaid. I have had Medicaid for years. The man I have spoken to about this looked me up and said I was. He will be taking care of it for me. I would prefer to get full mouth implants, but I see that I can’t. I have many health conditions. I thought that it might be possible, especially since it is all over the internet that Medicare pays for implants. I was optimistic and couldn’t,t wait until I was eligible to get them. But, I asked my dentist and he said no, Medicare nor Medicaid pays for them. I have 2 partials and I have never been able to eat with them! Not even once. They either come off in my mouth when I’m chewing or they stop fitting in my mouth, everytime. It is very frustrating that you have to eat without teeth. I’ve been lucky for a little while because I have molars on my right upper and lower side of my mouth, so I chew everything there. But, I can feel those two teeth are rotting away, when I touch them or what I have been able to see, so once they are pulled, I don’t know how I will be able to eat anything I would have to chew.
Carla, I only have Medicaid and I make just a little more than you do. Medicaid paid for pulling the teeth out that need to be pulled, and they fit me for two partial dentures. Partial Dentures are used to put teeth where there are no teeth. I didn’t have to pay a penny. Go to a dentist and they should help you. Just make sure you wear them more often than not or ask them how many hours s day you should, or they may stop fitting and you will have to have them adjusted. I hope you see this and go to the dentist and get the partials. I am so sorry 💔 about your son.
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.
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.
Great point. It is completely unnecessary, physically and obviously that my Medicaid won’t pay in full for the back of my teeth on top and bottom on each side as well. I can’t eat an apple due to only having gum line instead of my teeth. I have no way of eating regularly without chewing with only my front teeth. It definitely looks ridiculous the way I have to eat in order to chew without using the teeth that were extracted out the back my mouth. Please somebody give me an answer as to where I can go to get this fixed! Thank You!
This is so true. I am 39 and recently had a heart attack. And the only reason my heart and coronary health is as deteriorated as it is, is because I have had high blood pressure for quite a while and couldn’t get health care coverage that I could afford. And since I couldn’t afford to cover the costs of the medications I needed to control the hypertension not a single dentist would touch my teeth. Too much of a risk factor with a high blood pressure patient. So I couldn’t get dental care because I couldn’t afford the health care and because I couldn’t get the dental care my teeth health has greatly fallen. I’ve lost teeth had teeth crumble and break off at their roots. Couldn’t even get the broken teeth extracted😭 blood pressure was too high. When I finally qualified for state health insurance and got stabilized on my blood pressure medication enough to have my numbers low enough for a dentist to see me I couldn’t get a dentist that was practicing in office currently because of the pandemic their recordings would say. Couldn’t even get a dentist that was contracted for the state insurance to do an emergency appointment for me either. As a result to not being able to get dental care when I needed it I now have multiple heart problems and have had at least one major heart attack and multiple small ones because as most of us find out usually way too late is that our teeth and heart health are directly connected 😭 and I will likely have to lose all of my teeth to save my heart and life… it isn’t flipping fair😭 I had no control over any of it. My teeth decayed so badly due to me have acid reflux for so long and the acids destroyed my teeth over the years… so I’m 39 am going to end up losing all my teeth because I fell through so many gaps in our systems for so long and have terrible heart health now too. When something like this happens to a single mom who has paid into the system her entire life there is something wrong with the system. I shouldn’t have to get dentures. I should be able to have implants at my age. I should have been able to get health help to gain dental help to prevent ending up with such horrible heart health. Thanks state of Oregon. Thanks a lot man. Smh. 😭 I hate this…