Medicare does not typically cover dental procedures, unless they are a part of emergency or complicated services. However, Medicare Advantage plans or other supplemental insurance can help a person cover all or a portion of dental care costs.
Around 37 million Medicare enrollees do not have any level of dental coverage, according to the Kaiser Family Foundation.
However, there are other methods of securing routine dental coverage, even if it is not through Medicare itself.
In this article, learn about when Medicare may cover dental costs and how to secure coverage when it does not.
Medicare may cover dental costs that are a part of treatment for an underlying medical condition or injury. Examples of dental services that Medicare may fund include:
- dental extractions for cancer treatment involving the jaw or nearby soft tissues
- jaw reconstruction following an accident or injury
- oral examinations before a heart valve replacement or kidney transplant
Different aspects of Medicare may pay for these services. For example, if a non-dentist physician performs the surgery, Medicare Part B will pay for the costs. Part B is the medical portion of Medicare that usually funds doctor’s visits and related services.
If a dentist on a hospital’s staff performs the procedure, however, funding may come from Medicare Part A. This portion pays for in-hospital care, facilities, and treatment.
However, for the most part, Medicare does not cover routine dental services. This includes cleanings, extractions, and checkups that do not relate to an injury or condition that requires hospitalization.
Also, Medicare does not fund any replacements of lost or extracted teeth, such as dentures and fillings.
Medicare Advantage, or Medicare Part C, is a form of Medicare that private insurance plans offer. Although plans vary depending on healthcare provider network, geographical area, and the private insurer, some provide coverage for routine dental care.
Medicare Advantage combines parts A and B, as well as some elements of Part D. This part accounts for prescription drug cover and some other services.
The types of plan available may depend on the area in which a person lives. Many Medicare Advantage plans involve visiting a particular physician or group of hospitals that has contracts with their Medicare Advantage plan.
The same may also be true for the dentists in a person’s area. A person may need to see an “in-network” provider to receive coverage for their dental services.
Anyone considering switching to a Medicare Advantage plan for improved dental cover should look at participating providers in their area, as well as which dental services the plan will fund.
Medicare supplement insurance, or Medigap, is a plan that allows a person to pay an additional premium every month. This premium can reduce the out-of-pocket costs that often accompany Medicare parts A and Part B.
Medigap plans do not cover dental insurance or copayments. They are a way to supplement Medicare costs. As Medicare does not provide dental benefits, Medigap does not help a person fund these.
If a person wishes to have Medicare-associated dental cover, they should select a Medicare Advantage plan that offers these benefits.
To enroll in Medicare Advantage, a person must first enroll in Medicare during their Initial Enrollment Period, which starts 3 months before their 65th birthday, includes their birth month, and extends to 3 months after their birthday.
If a person misses this enrollment period, they can enroll in Medicare during the General Enrollment Period, which starts in January and finishes at the end of March.
After this time, a person can sign up for a Medicare Advantage plan from April through June. They must be enrolled in Medicare parts A and B in order to select a Medicare Advantage plan. They will likely have to pay a copayment or deductible to cover some dental costs.
If a person does not want a Medicare Advantage plan, or if there are no suitable plans available in their area, they can choose to purchase a separate dental insurance policy.
Private health insurance companies offer plans that include dental cover. Before purchasing one, a person may wish to research the different plans available to them and select one that best suits their needs.
Other options for dental care include:
- contacting the local health department to find out if they offer free or low cost dental services at certain times
- applying for Medicaid benefits, which may help provide dental benefits to some individuals and families (income qualifications may vary by state)
- contacting local dental or dental hygiene schools to find out if they offer free or low cost services
Community organizations, such as the United Way, may also help a person find free or low cost dental services.
Good dental health is vital for overall health. In fact, researchers have linked poor dental health with a worsening of some medical conditions, such as diabetes and heart disease.
Even if Medicare does not cover dental health, a person can seek dental benefits through Medicare Advantage or other community health programs.
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