Oral health is an important factor in maintaining your overall health and well-being, and keeping up with regular checkups is essential. Many Medicare recipients wonder if their dental care, services, or supplies, might be covered by their insurance. Learn more about Medicare coverage for certain procedures, and what you can do to get coverage for routine dental care.
Understanding Routine Dental Care
Depending on your current state of oral health, there may be several procedures which would be considered routine for your dental care needs. This can include:
- Cleanings. This includes regular maintenance cleanings that remove plaque or stains, or deeper cleanings that treat periodontal disease and excessive build-up of plaque.
- Fillings. Used to treat cavities, fillings can be made of many different materials, such as gold, silver amalgam, porcelain or other composite materials made of plastic or resin.
- Other repairs. Root canals and crowns are sometimes necessary to repair broken teeth or deep cavities.
- Extractions. Badly broken teeth or teeth with a great deal of decay that cannot be repaired by other means may need to be be extracted. Impacted wisdom teeth may also require extraction.
- Dental prosthetics. Bridges, partials and full sets of dentures help the jaw stay aligned, assist with chewing tough or crunchy foods, and maintain a cosmetic appeal.
Medical Procedures that Require Dental Care
In some cases, certain medical procedures will require dental work to be done in order for a procedure to be completed or successful. Radiation treatment for head and neck cancers requires a dental evaluation and possible extractions for teeth that may be broken or decaying. This prevents complications like infection and necrosis of the jaw bone. Patients also undergoing organ transplants receive oral examinations to identify and correct broken teeth, cavities and decay. Immunosuppressant medications associated with transplant recovery can complicate dental care and come with a risk of developing gum disease and other issues. A broken jaw may also require certain dental repairs or extractions to take place before or during reconstructive surgery to repair the fracture.
Medicare Coverage for Dental Care
When it comes to routine dental care, Original Medicare Part A and Part B do not provide coverage in most circumstances. If a dental procedure is related to medical conditions such as reconstructive jaw surgery, transplant surgery or radiation treatment, then it’s possible that Original Medicare insurance will cover it because it is a medically necessary part of an otherwise covered condition.
These benefits may not extend beyond the point of treating the covered condition, however. If repairs or examinations occur after the covered condition is treated, Original Medicare does not continue to provide coverage for that dental care.
When the dental work is covered as part of treating these eligible medical conditions, it may be performed during a hospital stay or as an outpatient procedure. This will determine which part of Original Medicare, Part A or Part B, is used to determine your share of costs with regards to copayments, coinsurance and deductibles. Part A is Hospital Insurance and will help cover services and supplies you receive when you have been formally admitted into a Medicare-approved hospital. Part B (Medical Insurance) helps cover preventive services and medically necessary services and supplies.
Additional Medicare Coverage for Dental Care
Comprehensive coverage for dental care may be available through a Medicare Advantage (MA) plan, which will provide all the same benefits of Original Medicare Part A and Part B. Many MA plans include additional coverage at little to no extra costs, including dental care. This coverage can include routine checkups, cleanings, and X-rays to determine which dental procedures you may need.
Generally, you must use dentists that are “in-network” with your Medicare Advantage plan. Using out-of-network dentists and specialists can incur higher cost-sharing obligations that may require you pay in full for the treatment you receive. These policies are different for each Medicare Advantage plan provider, so check the list of benefits to determine the best fit for your individual needs.
If you have dual-eligibility with Medicare and Medicaid, it’s possible that Medicaid providers and programs in your area will offer coverage for some dental services. Your state’s Medicaid program can provide more details about possible eligibility and available services.