Medicare and Dental Care

How dental care is covered with Medicare

Even though our dental health is very important, Medicare programs do not cover all the dental care we might need. Keeping your smile healthy is a little tricky. We’ve outlined the options you have and how to best take advantage of what Medicare has to offer.

Original Medicare plans including Plan A and Plan B don’t offer extra benefits. On the other hand if you opt for a private Advantage plan it will include both of the above mentioned programs and possibly some level of dental care coverage you might need, if you decide to get the additional premium. These Advantage plans might have different specifications depending on the services they cover. Majority of them should cover basic oral exams, fillings, extractions, crowns and dental surgeries, which can be quite costly if they are not covered by any kind of an insurance. If you don’t have any dental coverage insurance all of the costs for your treatment and examinations will have to be paid from your own pocket.

Both Part A and Part B Medicare programs exclude the possibility of routine dental care coverage, and where people mostly get confused is that it might cover some procedures, but only under certain circumstances. In the Part A Medicare program where inpatient hospital coverage is included, a patient is eligible for dental care insurance when those procedures are necessary. For example, if for the sake of a certain medical procedure (both prior to or after the procedure) some dental procedure is required, it will be covered by Medicare.

Procedures such as dental examining, fillings, cleaning, inserting crowns or bridges, and dentures will not be covered by the Original Medicare plan.

Medicare will cover certain dental procedures and even dental hospitalization if it is cause by a major condition which can be health threatening. Although certain services will be covered by Medicare, the rest of the expenses including the dentist or potentially other specialists are fully paid by the patient.

Other than this, dental procedures covered by Medicare might also depend on the following treatments: life threatening transplants, surgeries, services needed for diseases such as oral cavity tumor or facial tumor, surgery or wiring for fractured jaws and fractured facial bones.

One more important thing to add is, that Medicare will not cover any following dental treatments and procedures following after the major surgeries and treatments. These ones will become the burden of your own.

Does Medicare include Dentures?

Unfortunately, Original Medicare program won’t cover for dentures, but there is a possibility that some of the private Advantage plans might help you pay for them. Most of the elderly are not very well informed on the subject of the dentures being or not being covered by Medicare. In fact, the fact that some of the advantage plans can help a patient pay for the dentures, makes the people confused. Medicare Advantage plans that cover Part A and B, although costly, can cover some of the routine dental services. However, the biggest issue is that some areas lack Medicare Advantage insurer to get accustomed with the specifications of the Medicare plans in the first place.

What is covered?

Since we have established that basic Medicare won’t coveryou dental care, we are left with the question what to do? For instance, if you receive any kind of dental service including regular examination,removal of dental plaque from teeth, cavity fillings, implantsoreven tooth pulling you will have to pay the full price of  those services. Although there are Medicare Advantage Plans thatmay cover your dental care, make sure that you are fully accustomed with the specification of your Medicare Parts A and B first so you could avoid paying great amounts of money.

However if your dental care in endangering your health in general or is needed as part of the service for another medical issue covered by Medicare, you will not be covered. One example where Medicare would cover for your dental care is if you require an oral check up if you are preparing for a kidney transplantation in a clinicor prior to aortic valve replacement. Furthermore if you had a jaw surgery and dental splits and wiring are needed, you will be covered by Medicare, as well as in any case of broken jaw operation. Another example where you can be insured by Medicarefor dental services is if you need radiation treatment for diseases such as oral cancer. In addition, costs of your dental care after the removal of a face tumor (when a ridge construction is necessary) will be covered.

It is necessary to point out, that even when the above mentioned medical procedures are considered, Medicare won’t beresponsible for any additional costs of dental servicesafter the initial ones have been performed. Let’s explain that in several examples.A person who has been inan accident and need a dental care due to that accident (jaw surgery), will have the costs covered by Medicare only forthat single procedure, excluding every procedure that might follow. Medicare will also cover any hospitalization fees due to a dental care procedure. For example if you need hospitalization and dental care is necessary due to a life-threatening condition, Medicare may cover your expenses. Even in this case you will be covered only for certain fees such ashospitalization,anesthetizationor scanning, but theadditional dentist expenses won’t be covered. Remember, Medicare will never cover dental costs that were excluded for Original Medicare such as dentures,even in the case where the patient is hospitalized.

If you are looking for an optimal solution for dental care and dental coverage you can turn to the following resources:

  • Medicare Advantage Plans
  • Medicaid
  • Reduced-cost or free dental clinics
  • Federally Qualified Health Centers
  • Community Health Centers
  • Donated dental service programs
  • Dental schools

If you are looking for the best solution and want to prepare yourself in advance you can turn to FAIR Health’s consumer cost search tool to better understand how much money you will be charged by professionals for different dental care services in different parts of the country.