Medicare usually does not cover dental procedures, unless it is a part of emergency or complicated facilities. Nevertheless, Medicare Advantage plans or other health benefits that help a person cover all or a portion of the cost of dental care.
According to the Kaiser Family Foundation, about 37 million Medicare enrollees have no amount of dental coverage.
But there are other ways to secure regular dental coverage, even if it’s not through Medicare itself.
Read in this article about when Medicare will cover dental expenses, and how to ensure coverage if not.
Does Medicare ever cover dental costs?
Medicare can cover dental costs that are part of the treatment for a medical condition or injury that underlies it. Some of the dental services covered by Medicare 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
These services may be paid for by different facets of Medicare. For example, if the surgery is done by a non-dentist, Medicare Part B will be responsible for the costs. Part B is Medicare’s medical part, which usually includes doctor visits and health services.
However, funds may come from Medicare Part A if a dentist on the staff of a hospital performs the operation. It portion pays for in-hospital care, services, and treatment.
However, Medicare does not provide regular dental services in the majority of cases. This involves cleanings, extractions, and checks not related to an accident or illness requiring hospitalization.
Also, Medicare does not fund any replacements of lost or extracted teeth, such as dentures and fillings.
What about Medicare Advantage?
Medicare Benefit, or Medicare Part C, is a kind of Medicare provided by private insurance plans. Although policies vary depending on the healthcare provider network, geographic area, and private insurer, some offer regular dental care coverage.
Medicare Advantage incorporates sections A and B, as well as some components of Portion D. This part provides coverage of prescription drugs and other programs.
The types of scheme available can depend on the area a person lives in. Some Medicare Advantage plans require visiting a single physician or hospital group that have provisions with their Medicare Advantage plan.
The same may apply to the dentists in a person’s region as well. An patient may need to see an “in-network” provider to get coverage for their dental services.
Those considering switching to a Medicare Advantage program for expanded dental coverage will look at participating providers in their area as well as what the package would support dental services.
What about Medigap coverage?
Medicare replacement care, or Medigap, is a program that allows an individual to pay an extra fee per month. This premium will cut the out- of-pocket costs that often follow sections A and B of Medicare.
Medigap plans do not cover copayments or dental insurance. These are a way to make Medicare benefit replacements. Because Medicare does not provide dental benefits, Medigap is not helping a individual finance these.
What can people aged 65 and over do about dental coverage?
If a person wishes to have dental coverage associated with Medicare, they should choose a Medicare Advantage program that provides such benefits.
A person must first enroll in Medicare during their initial enrollment period, which begins 3 months before their 65th birthday, includes their month of birth, and continues to 3 months after their birthday to enroll in Medicare Advantage.
If a person fails this period of enrollment, they can enroll in Medicare during the General Enrollment Period, which starts in January and ends in late March.
A individual might subscribe to a Medicare Advantage plan from April through June after this date. To choose a Medicare Advantage package, they must be participating in the Medicare sections A and B. They would probably be required before pay a copayment or penalty to cover any dental expenses.
If a person does not want a Medicare Advantage plan, or if there are no suitable plans in their state, we may choose to buy a separate dental insurance policy.
Private health insurance companies sell dental covered policies. A person may want to study the different plans available to them before buying one, and choose 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 United Way, can also help a person find dental services that are free or low-cost.
Good dental health is vitally important for general health. Reports have in turn linked poor dental health with a deterioration of other medical conditions, such as diabetes and heart disease.
Even if Medicare doesn’t cover dental health, a person can use Medicare Advantage or other community health services to receive dental benefits.