Many beneficiaries of Medicare want to know whether their medical coverage includes dental. Your Original Medicare will usually not cover routine dental services. A routine service can include oral examination, fillings, cleanings, implants, and extractions. There are major limitations on what is covered and under what circumstances.
Only essential parts of the Medicare-covered procedure are covered by Original Medicare. So, Does Medicare Cover Dental expenses? The answer is that it covers only a few select procedures depending on the circumstances.
Original Medical Dental Coverage
The Part A and Part B of Original Medicare don’t cover the following dental procedures:
- Oral exams
- Fillings and crows
- Dental appliances like dental plates or dentures
As already mentioned, there are a few exceptions to this basic rule. Medicare Part A can, at times, cover some dental procedures which are performed in a medical facility if it is an essential part of a covered medical service. Preliminary oral examination may be required before a surgery. Such dental services may be covered under Medicare. Oral examination will also be required as part of a reconstructive jaw surgery. Even in this case, the dental procedure may be covered because it is related to a different service which is covered under Medicare.
If you suffer from oral cancer, the required dental procedures related to the medical condition may also be covered under Medicare. When you receive such dental services as an outpatient, Medicare Part B may cover them. Part A covers inpatient emergency hospital care. It is important to know that once Original Medicare has covered a certain dental service, post-treatment dental services may not be covered. So if you received coverage for reconstructive jaw surgery, further dental care services will cease to be covered.
Medicare can cover certain dental services if they are essential for protecting your general health or if dental care is required as part of another health service that is covered. Some of these other examples include the following:
- Oral examination in a medical facility as part of procedures like kidney transplant, any other organ transplant that is covered under Medicare, or heart valve replacement.
- Removal of facial tumor and for ridge reconstruction. Ridge reconstruction involves reconstructing a part of the jaw.
- A disease, like oral cancer, that also affects the jaw. Dental services may also be required as essential part of radiation treatment.
- Dental wiring and splints are required due to jaw surgery.
- Surgery for treating fractures in the face or jaw.
Some of the dental-related hospitalizations covered by Medicare can also include infection developed after having removed a tooth. It can also cover observation during a dental procedure, as you already have a health-threatening medical condition.
Even when Medicare covers these dental services, it is not going to pay for follow-up dental care once the medical condition has been treated. In simple terms, it is not going to cover post-treatment dental services. If it paid for tooth removal as part of facial surgery due to an accident, you shouldn’t expect it to pay for additional dental care required later because the tooth was removed.
Dental Coverage Under Part C
You can see that there are so many limitations on how much dental coverage you can get under Original Medicare. There are certain options under Medicare Part C that can provide you more dental coverage. But these additional covers are provided through Medicare-contracted insurance carriers. Such plans must provide the minimum same level of coverage as Original Medicare. Eventually, this means that such a plan is going to cover dental care under same conditions as Original Medicare. Some plans under Part C can offer extra benefits like coverage for routine dental care, prescription drugs, and wellness programs.
Even the dental services covered under Medicare Part C program may need you to receive care under provider networks. If you have to receive care from non-network dentists, it is highly likely to come at higher cost-sharing. The details will vary from one plan to another. When you choose a plan, there could be certain costs relevant to the coverage you receive. This can include copayments, deductibles, or coinsurance. Even when you enroll in Part C plan, you will have to pay the Part B premiums.
Senior Dental Coverage
When it comes to senior dental plans, you will have to enroll in a standalone dental program. There are several optional dental plans for seniors, including:
- Part C or Medicare Advantage Plans
- Choose Medicare Supplement Insurance
- Choose a standalone dental insurance plan
- Enroll in a dental discount plan
- Consider enrolling in your spouse’ dental plan
So keep all these points in mind when choosing the right Medicare plan. It will require some research and professional guidance to find a program that provides you optimal coverage based on your requirements.