Many Medicare beneficiaries wonder if their plans cover the cost of dental implants. Understanding this can be confusing, as coverage varies widely between different plans and providers. We dug deep into Medicare's Evidence of Coverage (EOC) documents to get the answers for you.
How We Found the Answers
We combed through the EOC documents for the major Medicare providers.
When the EOC clearly stated coverage, we took a screenshot and highlighted the relevant section. If a benefit wasn't mentioned, we assumed it's not covered.
We also looked at different plan types (HMO, PPO, etc.) and noted variations in coverage between plans.
Screenshot from Aetna Medicare Select (HMO) Evidence of Coverage document showing the section detailing coverage for dental implants.
Aetna Medicare Select (HMO): Covers 1 implant per tooth every 5 years.
Aetna Medicare Assure Plus (HMO D-SNP): This enhanced plan does cover dental implants.
Other Aetna Medicare Plans: Most other Aetna Medicare plans do not cover dental implants.
Anthem Medicare Advantage (HMO) Medicare Plan - Confirmation of Dental Implant Coverage (Page 62)
All Anthem Plans: Cover dental implants, but the coverage amount varies for each plan.
Screenshot from AvMed Medicare Access (HMO-POS) Medicare Evidence of Coverage document showing the section detailing coverage for dental implants.
AvMed Medicare Access (HMO-POS): Covers dental implants with a copay.
Other AvMed Medicare Plans: Do not cover dental implants.
All Blue Cross Blue Shield Plans: Do not cover dental implants.
All CarePlus Plans: Do not cover dental implants, but some plans cover cleaning (prophylaxis) on existing implants.
All Cigna Healthcare Plans: Do not cover dental implants.
All Clear Spring Health Plans: Do not cover dental implants.
All Clover Health Plans: Do not cover getting new dental implants but do cover removing and repairing existing implants.
All Devoted Health Plans: Do not cover dental implants.
All Freedom Health Plans: Do not cover dental implants.
All Gold Kidney Health Plans: Do not cover dental implants.
HealthSun HealthAdvantage Plan (HMO) Medicare Plan - Confirmation of Dental Implant Coverage (Page 64)
HealthSun HealthAdvantage Plan (HMO): Covers up to two dental implants per year.
HealthSun MediSun Plus (HMO D-SNP): Covers up to two dental implants per year.
Other HealthSun Health Plans: Do not cover dental implants.
Humana Fully Integrated (HMO D-SNP) Medicare Plan - Confirmation of Dental Implant Coverage (Page 78)
Humana Fully Integrated (HMO D-SNP): Covers dental implants with a $5,000 annual maximum.
Humana Gold Plus SNP-DE (HMO D-SNP): Covers dental implants with a $2,500 annual maximum.
Other Humana Plans: Do not cover dental implants.
Kaiser Permanente Senior Advantage Basic 1 (HMO) Medicare Plan - Confirmation of Dental Implant Coverage (Page 104)
All Kaiser Permanente Plans: Cover one dental implant procedure per year.
Prominence Plus HMO Medicare Plan - Confirmation of Dental Implant Coverage (Page 52)
Prominence Plus HMO: Covers dental implants (limit of 2) as part of a $4,000 combined limit for preventive and comprehensive dental care.
Other Prominence Health Plans: Do not cover dental implants.
Simply Extra Platinum (HMO) Medicare Plan - Confirmation of Dental Implant Coverage (Page 100)
All Simply Healthcare Plans: Cover dental implants, but some may require prior authorization.
All Solis Health Plans: Do not cover dental implants.
All Sonder Health Plans: Do not cover dental implants.
UHC Care Advantage FL-E001 (PPO I-SNP) Medicare Plan - Confirmation of Dental Implant Coverage (Page 111)
UnitedHealthcare Nursing Home Plans: Covers dental implants with annual maximums
Other United Healthcare Plans: Do not cover dental implants
2024 Wellcare Dual Liberty (HMO D-SNP) Medicare Plan - Confirmation of Dental Implant Coverage (Page 70)
2024 Wellcare Dual Liberty (HMO D-SNP): Covers 2 dental implants (and related services) every 12 to 84 months, depending on the type of service.
Other Wellcare Plans: Do not cover dental implants.
While Original Medicare (Parts A and B) generally doesn't cover dental implants, many Medicare Advantage plans do offer some coverage. If you're considering dental implants, it's crucial to carefully review your plan's EOC or contact your provider directly to confirm coverage details.
If you have further questions or need help from a licensed professional, you may contact us.
Need More Information? For a deeper dive into Medicare Advantage plans and their benefits, check out our comprehensive guide on Medicare Advantage Plans.
Disclaimer: This post is for informational purposes only and should not be considered financial or medical advice. Always consult with a qualified professional for personalized guidance.
Important Note: Benefits may vary depending on your location and carrier. Please check your service area for the specific benefits offered by your plan.
Dental implant coverage varies significantly among Medicare Advantage plans. Some plans offer coverage for implants, while others do not cover them at all or only cover certain related procedures like removal or repair. It's essential to check the details of your specific plan.
The average cost of a single dental implant can range from $1,500 to $6,000 or more. This cost typically includes the implant itself, the abutment, and the crown. Additional procedures like bone grafting can increase the total cost.
Yes, there are alternatives to dental implants, such as dentures and bridges. Dentures are removable appliances that replace missing teeth, while bridges are fixed appliances that are anchored to adjacent teeth. These options are often more affordable than dental implants but may not be suitable for everyone.
Yes, you can purchase a stand-alone dental insurance plan to help cover the cost of dental implants if your Medicare Advantage plan doesn't offer sufficient coverage. Some dental insurance plans offer coverage for implants, but waiting periods and annual maximums may apply.