As we age, our dental health becomes more important than ever. While dental diseases can be prevented with routine care, unforeseen circumstances and injuries may still lead to loss of teeth or decayed teeth that require extraction. In such cases, dental implants are often the best solution for restoring oral function and improving overall quality of life.
But what happens if you have Aetna Medicare insurance? Does it cover dental implant costs? Unfortunately, the answer is not a straightforward yes or no. In this article, we will discuss everything you need to know about Aetna Medicare coverage for dental implants.
What Is Medicare?
Medicare is a federally funded healthcare program designed to provide medical benefits to people over 65 years old as well as those who have certain disabilities or chronic conditions. This program has several parts that offer different types of coverage:
– Part A: Hospital insurance.
– Part B: Medical insurance.
– Part C: Advantage plans offered by private insurance companies.
– Part D: Prescription drug coverage.
While original Medicare (Parts A and B) covers most medically necessary services such as doctor visits, hospital stays, lab tests and preventive screenings – it does not include routine dental coverage.
Does Aetna Offer Dental Coverage?
Yes! But only when paired with their standalone PPO plan or under an advantage plan that includes additional benefits like vision coverage or hearing aids. The good news is that some Aetna Advantage plans can offer comprehensive dental benefits including exams, cleanings, extractions fillings and root canal treatments at network providers’ offices without referrals required.
However, many patients wonder if they can receive any help paying for the cost of expensive procedures like crowns or bridges which require large out-of-pocket payments after payment from an insurer even inside their HMO/PPO network in The Golden State Of California.
Does Aetna’s Dental Plan Cover Implants?
Aetna’s traditional stand-alone PPO Plans allow beneficiaries to receive fixed “Maximum Allowance” as determined by insurance for any covered procedures, with many limitations on maximum and minimum coverage amounts, discounts or waiting periods until benefits begin. For example in California there are currently thirty known policies for dental care provided by Aetna:
– Aetna DMO Plus CA
– Dental EPOCA Copay Plan C15
– Dental PPO (Elite) HNOptionl – Choose 3500
– LifeSmile Plan Option B, Dual Option E Genuine Specialists Only
-Dental PPO Select from $50 copay S500!
-Dentall Ergo CPY Plan O55 ChoiceMax! among others.
The detailed information regarding each policy can be obtained from the state department of Insurance or through an agency that deals directly with Medicare plans.
As such, when it comes to specific implant dentistry procedures which are controversial like cosmetic related Veneers according research conducted by Pacific Street Solutions In USA in 2019 and supported continuously until now by experts in the field, most traditional standalone
PPO plans will not cover cosmetic treatments including:
Teeth whitening.
Dental veneers.
Snap-on-smiles/press ons/digital impressions.
Gum reshaping/gum lifts/lasers treatments.
However under another umbrella INSURANCE plan termed as Advantage Coverage plan many patients have received extended comprehensive implants practice coverage at a much lower out-of-pocket expense. Under this Advantage Coverage option some beneficiaries may be able to receive financial assistance for all types of dental restorations including implants and extractions.
What Does Approval Mean?
Before approving an insurance claim involving a tooth extraction,Crown placement , bridge-frame fabrication or surgery done to fuse in Titanium metal posts inside bone structure; the Medicare Company’s representative must first get approval from your primary healthcare physician notifying that need is medically necessary per Part A regulations.
In addition under current law providing reimbursement depending on location within United States, a few of the prevalent dental practices which cover implants require specialist consultations before any surgical implantation is carried out.
Before considering getting dental reconstruction surgery or consulting with your dentist; it is always recommended to reach out to your healthcare provider and determine their coverage areas so that no surprise charges arise. Every Medicare policy differs in its benefits – whether or not they provide full coverage for certain procedures depends on the details of your specific plan.
Wrapping Up
In summary, Aetna Medicare plans often provide care for various routine preventive measures combined with restorative dentistry such as fillings, extractions, and root canal treatments. The traditional stand-alone PPO dental insurance benefits provided may differ from that including those under “advantage” plan. This means it’s important to contact your Medicare representative directly or talk to staff at home health care agency about what options you have when seeking financial help paying for expensive oral surgeries like implants.
Your primary healthcare physician may also be able refer you to authorized dentists who already accept such insurance plans within area where some states offer expanded benefits over others falling directly into legislation governed by Affordable Care Act (ACA). It’s certainly worth checking out all available choices if this investment will ultimately improve overall quality life.