Dental implants have become increasingly popular as a long-term solution to replace missing teeth. Even though these procedures are usually expensive, affordable dental implant options are now available for older adults.
Average American adults aged 45-64 are missing five teeth, while 18% of those aged 65 and older are missing all their teeth. So, does Medicaid pay for dental implants?
Although dental implants aren't usually covered by Medicaid, there are certain instances when they are considered medically necessary or eligible for health insurance.
Does Medicaid Pay For Dental Implants For Adults
The popularity of dental implants is leading Medicaid beneficiaries to wonder if their dental benefits cover them. There is no simple answer to this question.
Medicaid does not cover dental implants as a basic procedure. For the program to cover the costs of the procedure, it must be determined that the procedure is medically necessary. Dental coverage under Medicaid may cover some tooth repairs as well as some dental implants.
Take note that the program covers different dental treatments depending on where you live. Additionally, Medicaid may cover implants if eligible senior citizens on Advantage plans need them for dental health reasons like decay or periodontitis.
How To Get Medicaid To Cover Your Dental Implants
A dental implant must be proven medically necessary, which means it will improve the function of the teeth, such as chewing. Also, the procedure must be the least expensive treatment. In such cases, teeth loss must occur due to conditions in the body, such as periodontal disease, diabetes, or severe dental problems. A detailed medical evaluation by your physician and dentist and a treatment plan will be required.
EPSDT Benefits
Children on Medicaid are entitled to benefits under Early And Periodic Screenings, Diagnostics, And Treatment. The program is open to children up to the age of 21. In the case of dental implants for children under 18, Medicaid often pays just a portion of the overall cost.
Special Consideration
It may be possible for a patient to get approved for a dental implant if they demonstrate a significant, documented medical need. The dentist or physician has to explain why implants are necessary in the treatment paperwork. Take note that implants will likely still not be covered by the program.
Frequently Asked Questions
Below, we have answered some of the most commonly asked questions about Medicaid and dental implants:
Before starting any treatment, your dentist will use a local anesthetic. This will numb any pain from the procedure, but you may feel some discomfort. The local anesthetic, along with the painkiller, will ensure a mostly pain-free process.
As kids and teens still have developing jaws, dental implants are not suitable. Dentists also avoid performing surgery on people 85 and older. Those with bad oral health, gum decay, smokers, or people with bad oral habits are not ideal candidates. Also, people with health conditions like diabetes, autoimmune disorders, osteoporosis, or systemic diseases should not receive implants.
A single dental implant with a porcelain crown can cost $3,500 to $6,700. This includes the cost of the implant device and its placement. Full mouth implants cost an average of $43,000 and may reach $56,000.
Other Ways To Pay For Dental Implants
The cost of dental procedures can be prohibitive for an average person. This is why many people ask, “does medicaid pay for dental implants?”
If Medicaid doesn't cover your dental implants, you can apply for a Cosmetic Dentistry Grant (CDG), private dental insurance, dental schools, or various dental grants and programs. Our resource on government grants for dental implants can also help individuals learn more about their financial options.
