Blog Does Medicare Cover Dental Care Services

Does Medicare Cover Dental Care Services

Essentially, Medicare is a federal health insurance program for individuals who are 65 years and above, younger people living with disabilities, and people with end-stage renal disease.

There are several misconceptions about what it covers and doesn’t cover. Here in this article, we focus on its dental care services and its coverage type. Read on! 

Contents

Medicare And Dental Services 

Medicare doesn’t cover most dental procedures and services like cleanings, dentures, fillings, dental plates, tooth extractions, and other dental devices. However, some Medicare plans offer limited dental services and procedures coverage.¬†

This will depend on your Medicare plan, of which several types of dental care services exist, namely: 

  1. Original Medicare comprising
  2. Part A (Hospital Insurance)
  3. Part B (Medical Insurance)
  4. Medicare Advantage (Part C), which combines Part A (Hospital insurance) and Part B (Medical Insurance) and may also cover Part D (Prescription Drugs), Dental, Vision, and other programs which are not going to cover under the Original Medicare (Part A and Part B).
  5. Part D (Prescription Drugs)
  6. Medicare Supplement Insurance or Medigap covers out-of-pocket costs not covered by Original Medicare.

Dental Cover Vs Medicare Types

Original Medicare, which includes Part A (Hospital insurance) and Part B (Medical Insurance), doesn’t cover dental supplies and procedures. However, life-threatening situations requiring hospitalization related to dental health are covered under dental care services.

Original Medicare covers dental care vital for a patient’s general health or dental care necessary for another Medicare-covered service to succeed. Dental services and procedures that you may have access to under Original Medicare include and are not limited to the following: 

  • An oral examination is required before a kidney transplant.
  • The oral examination is considered necessary before a heart valve replacement is performed in a Federally Qualified Health Centre (FQHC) or a rural clinic.
  • Surgery for treating fractures in the face or in the jawline.
  • Dental services are necessary for radiation treatment for jaw-related illnesses like oral cancer.
  • Ridge construction involves reconstruction, which is a part of the facial tumor’s removal operations.
  • Dental splints are performed right after jaw surgery.

Original Medicare only covers the initial services mentioned but will not cover any subsequent or follow-up dental care or procedure after the underlying health condition has been treated.

For example, Original Medicare may cover your tooth extraction as part of facial surgery in case you are involved in an accident but will not pay for the follow-up dental care and procedure needed due to having the tooth removed.

The dental care services and original Medicare may also cover some tooth-related hospitalization cases, like observation required during a dental procedure because you may have a health-threatening condition.

In such cases, Original Medicare will cover the hospitalization costs, including room and board, x-rays, and anesthesia. However, it will not cover the fees for dentists or other physicians like radiologists and anesthesiologists. 

Moreover, while Original Medicare covers in-patient hospital care-related health-threatening conditions, it never covers dental services not included in the Original Medicare plan, like dentures. 

For instance, even if you are hospitalized, you must pay out-of-pocket for dental services and procedures not covered under your Original Medicare plan.

What Is The Medical Advantages MA Plan Of Part C?

Medicare Advantage (MA) plans or Part C are offered through private insurance companies approved by the Government Medicare program. They may cover routine dental services and procedures based on your insurance provider and plan. 

It is, therefore, important to consult your Medicare service provider to inquire if they cover dental services and procedures. 

Dental services covered under Medicare Advantage plans are mostly basic or routine dental services that comprise: 

  • Fillings
  • Extractions
  • Teeth cleaning
  • Routine X-rays
  • And other services covered under your Medicare Advantage plan

Medicare Advantage plans usually limit the dental coverage they offer clients based on maximum cost allowances, the number of dental services you can access in a year, and other limits based on your Medicare plan provider. These dental care services and their limits can also be imposed on the services and procedures you can access under your Medicare Advantage plan. 

Medicare Supplement Insurance or Medigap helps pay costs not covered by the Original Medicare plan. However, Medigap does not cover dental services and procedures; therefore, having a Medigap plan will not cover your dental services and procedures but may cover costs related to health-threatening dental illnesses covered under the Original Medicare plan. 

Is Medicare Enough For Dental Care Cover? 

The Medicare plan you choose will determine the level of dental services and procedures you can access. Original Medicare will offer no coverage for dental services and procedures save for dental care necessary during critical health-related procedures while not covering routine dental services and procedures under normal circumstances. 

On the other hand, the Medicare Advantage plan is limited to your Medicare provider’s dental plan. Based on these facts, it may be implied that Medicare may not offer you the best dental care services and procedures coverage.

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