Does Medicare Pay for Implants? The Surprising Answer and What You Can Do

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Implants are devices that replace or support body parts, like teeth, hips, breasts, or heart valves.

Implants can improve your appearance, function, and quality of life, but they can also be very expensive.

If you are a Medicare beneficiary, you may wonder if Medicare pays for implants and how much you have to pay out of pocket.

This article will explain implants, their costs, and how to pay for them.

Does Medicare pay for implants? Find out which types of implants are covered, how much they cost, and what alternatives you have.
Does Medicare pay for implants? Find out which types of implants are covered, how much they cost, and what alternatives you have.
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What Types of Implants Does Medicare Cover?

An infograpic on Types of Implants Covered by Medicare
An infograpic on Types of Implants Covered by Medicare

Medicare is a federal health insurance program for people 65 or older, disabled, or with certain diseases.

It has four parts: A (hospital), B (medical), C (Advantage), and D (drugs).

Each part covers different services and supplies, including some implants.

Implants are artificial devices that replace or support a body part, such as a tooth, a hip, a breast, or a heart valve.

Medicare covers implants that are medically necessary, meaning they are needed to diagnose or treat a condition, injury, or illness.

It does not cover implants that are cosmetic, elective, or experimental, meaning they are not essential for health or well-being.

Medicare also does not cover implants that are not FDA-approved or from a non-certified provider or facility.

Here are some examples of implants that Medicare may or may not cover:

  • Dental implants: Medicare covers them only if they are part of a reconstructive surgery after a jaw or face injury or disease, like oral cancer. Medicare does not cover them for routine dental care, like replacing teeth or improving smile.
  • Hip implants: Medicare covers them only if you have a hip problem that causes pain or disability, like a fracture or arthritis. Medicare does not cover them for preventive or cosmetic reasons, like enhancing mobility or appearance.
  • Breast implants: Medicare covers them only if you have a breast removal surgery due to cancer or disease. Medicare covers breast reconstruction surgery, which may include implants, to restore breast shape and size. Medicare does not cover them for breast enlargement or improvement, like increasing cup size or symmetry.
  • Heart valve implants: Medicare covers them only if you have a faulty or diseased heart valve that affects blood flow and causes symptoms, like chest pain or fainting. Medicare covers heart valve replacement surgery, which may include implants, to improve heart function and quality of life. Medicare does not cover them for preventive or cosmetic reasons, like lowering heart disease risk or boosting athletic performance.

How Much Does Medicare Pay for Implants?

Medicare is a federal health insurance program for people 65 or older, disabled, or with certain diseases. It has four parts: A (hospital), B (medical), C (Advantage), and D (drugs). Each part covers different services and supplies, including some implants.

Implants are artificial devices that replace or support a body part, such as a tooth, a hip, a breast, or a heart valve. Medicare pays a fixed amount for each service or supply, based on a fee schedule or a payment system. You pay the rest, which may include deductibles, coinsurance, copayments, and excess charges.

Here are some examples of how much Medicare pays for implants and what you pay:

  • Dental implants: Part A covers hospital costs, such as room, anesthesia, and implant. You pay $1,484 deductible per benefit period, and $371-$742 coinsurance per day. Part B covers doctor’s services, such as consultation, evaluation, and surgery. You pay $203 deductible per year, and 20% coinsurance. Part C and D may cover more or less, depending on your plan. You may pay premium, copayment, or excess charge.
  • Hip implants: Same as dental implants.
  • Breast implants: Same as dental implants, but only if you have breast removal surgery due to cancer or disease.
  • Heart valve implants: Same as dental implants, but only if you have faulty or diseased heart valve that affects blood flow and causes symptoms.

What Are the Alternatives to Implants?

If you need or want an implant, but Medicare does not cover it or you cannot afford it, you may have some alternatives to consider, such as:

  • Other types of prosthetic devices, such as dentures, bridges, crowns, partials, braces, or retainers for your teeth; artificial hips, knees, or shoulders for your joints; breast forms, bras, or clothing for your breasts; or pacemakers, defibrillators, or stents for your heart. These devices may be less expensive, less invasive, or more accessible than implants, but they may also have some drawbacks, such as lower durability, comfort, or appearance.
  • Other types of treatments, such as medications, injections, physical therapy, or lifestyle changes for your medical conditions. These treatments may help you manage your symptoms, improve your function, or prevent further complications, without the need for surgery or implants. However, they may not be as effective, long-lasting, or satisfying as implants, and they may have some side effects, risks, or limitations.
  • Other types of insurance, such as dental insurance, supplemental insurance, or Medicaid. These types of insurance may cover some or all of the costs of implants, depending on your eligibility, your plan, and your provider. However, they may also have some restrictions, exclusions, or requirements, such as waiting periods, pre-existing condition clauses, or prior authorization.

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Conclusion

Medicare pays for implants that are medically necessary, but not for implants that are cosmetic, elective, or experimental.

The amount that Medicare pays for implants depends on the type of implant, the type of surgery, the type of Medicare plan, and the location of the service.

You are responsible for paying the remaining amount, which may include deductibles, coinsurance, copayments, and excess charges.

 

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