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Medicare Dental Coverage Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician. Statutory Dental Exclusion Section 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services." Background The dental exclusion was included as part of the initial Medicare program. In establishing the dental exclusion, Congress did not limit the exclusion to routine dental services, as it did for routine physical checkups or routine foot care, but instead it included a blanket exclusion of dental services. The Congress has not amended the dental exclusion since 1980 when it made an exception for inpatient hospital services when the dental procedure itself made hospitalization necessary. Coverage Principle Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed. Services Excluded under Part B The following two categories of services are excluded from coverage: A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw. A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition (e.g., tumor removal) and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, the Medicare payment amount should not include the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth (e.g., alveolar process). Exceptions to Services Excluded The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease. An oral or dental examination performed on an inpatient basis as part of comprehensive workup prior to renal transplant surgery or performed in a RHC/FQHC prior to a heart valve replacement. Definition Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets).

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15y ago
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Wiki User

10y ago

No Medicare does not usually cover dental implants unless it is needed as a part of a larger dental surgery or reconstruction surgery after an injury. For more information, see the government's Medicare website: http://www.medicare.gov/coverage/home.asp

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Jayliana Jenkins

Lvl 4
3y ago

Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. It will pay for certain dental services that you get when you're in a hospital.

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Wiki User

9y ago

Typically Medicare will not pay for dental implants. Medicare may possibly pay for the dental implants if reconstruction of the jaw or mouth was required.

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Wiki User

14y ago

Medically necessary dental services is covered but call your provider first. Some Medicare Advantage plans regular dental benefits.

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Linda Burbage

Lvl 2
1y ago

Does Medicare or Medicaid pay for reconstruction of the jaw and implants_

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Anonymous

Lvl 1
3y ago

Do you get money for a crowne

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Anonymous

Lvl 1
3y ago

No

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Q: Does Medicare pay for dental implants?
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Does Medicare pay dental implants?

Medicare covers the essential part of a medicare-covered procedure. They may cover dental implants if it is part of a reconstructive surgery post injury but it does not cover the cost of dental implants for a simple replacement of a tooth.


Does medi-cal pay for dental implants?

I've researched this quite a bit, the only things medi-cal, medicaid, and medicare cover is pulling your teeth out, implants are considered cosmetic. So no they will not cover implants.


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Does Medicare help pay cost of Implants. I lost my teeth from physical abuse and am on Social Security Disability?

They are so painful, as I said there are others that offer the snap on, and yes your ins will pay Medicare will only pay for dental implants if they are part of a facial reconstruction because of injury or disease. If your teeth were lost without other devastating facial injury, they won't pay for implants, but should cover dentures. I dont think Medicare covers implants. I have 3 of them. and medicare did not cover them. And Implants are Great. wish I could afford to do all my teeth that way..also some medical ins. will cover the surgical part of the implant. as mine did. hope this help. good luck


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