Getting Dental Coverage Under Medicare (Health & Beauty - Life Insurance)

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Getting Dental Coverage Under Medicare

For seniors, one of the most important questions we at IPA hear about Medicare is whether or not it provides coverage for dental care. Unfortunately, the answer is not quite as simple as a yes or no. The kind of Medicare coverage you need for dental care, including oral surgery, will largely determine which Medicare plan is right for you.

Types of dental coverage available under Medicare

Generally speaking, Original Medicare (Part A and Part B) does not cover routine dental care such as fillings, tooth extractions or dentures. However, it may cover certain dental services that are deemed medically necessary, such as those provided in connection with a hospital stay or specific treatments like jaw reconstruction for cancer patients. It is also important to note that some private insurance providers offer optional stand-alone dental plans specifically designed for seniors enrolled in Medicare Advantage plans.

Under Medicare Advantage programs and certain medicare supplement plans (Medigap), you can receive benefits for bridgework and crowns as well as other preventive care. Additionally, services related to medically necessary care like treatment for mouth infections or facial pain relief are included.

What exactly is covered under Medicare?

Overall, dental coverage under Medicare is relatively limited, depending on the plan you have. Specifically, preventive dental services like cleanings and X-rays may be covered with some Medicare plans, though there may be a copayment required. Basic restorative treatments such as fillings, extractions and dentures may be partially covered if deemed medically necessary.

Medicare defines “medically necessary” as health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. Each state (including Arizona) may have a definition of “medical necessity” for Medicaid services within their laws or regulations.

Resins and crowns, however, are not usually covered under Medicare plans. If you choose to purchase additional dental coverage through a supplemental plan or Medicare Advantage plan it may provide more extensive coverage for many routine and complex dental needs.

Does oral surgery (such as root canals) fall under Medicare dental coverage?
It is an important question to ask if dental plans available under Medicare also cover oral surgery. The answer (again) is not a simple yes or no. Some plans may offer coverage for very specific types of oral/dental surgery. You may also be covered if you are considered to have any pre-existing conditions since this can have an effect on the types of surgeries that are covered. But overall, it is important to know that the Medicare coverage offered by dental plans vary widely, so you shouldn’t rush to choose one without exploring all your options.

How to get dental coverage under Medicare

Although most of the Original Medicare plan does not cover routine dental care services, there are options available to help you out. One way is by purchasing a stand-alone dental plan, which some private insurance companies offer. Another way is through a Medicare Advantage plan that includes additional coverage for dental treatments and procedures. You can also choose to add a dental discount plan if you do not wish to purchase more expensive plans from private companies.

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Last Update : May 03, 2023 5:12 AM
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