Medicare coverage for dental services can be confusing, limited and leave many with immense, unaffordable out of pocket costs. As a Medicare beneficiary it is important to know what is covered by Medicare when it comes to dental care.
Original Medicare will not cover dental care that is needed for the health of your teeth. This type of dental care includes routine checkups, cleaning, fillings, dentures and implants. There are some cases when Original Medicare will cover dental services, but generally this is only the case if the dental work is needed to protect your general health OR if the dental care is needed because of another health service you are receiving that is covered by Medicare. Some instances may include:
- If you are in the hospital, or qualified health clinic for a kidney transplant or to receive a heart valve replacement and you need to obtain an oral exam
- Dental services that are necessary for radiation treatment of a disease that involves the jaw such as oral cancer
- If you have jaw surgery and need wiring or dental splints as a result.
- If you need surgery to treat and repair a jaw fracture
- If you had a facial tumor removed and need reconstructive surgery on part of your jaw as a result of the surgery
Even in these instances Medicare will not pay for any needed follow up dental work. For example, if you need a tooth extraction before a Medicare approved surgery, and Medicare covers the cost of the tooth removal, Medicare will not cover any cosmetic care after the fact.
There are other instances in which Medicare will cover the cost of procedures for dental related hospitalizations, such as hospitalization because of a tooth infection, or a hospitalization during a dental procedure because of a life threatening health condition. In an instance such as these, Medicare will cover the cost of hospitalization services such as room and board, x-rays and anesthesia but it will not cover the dental fees for treatment or physician’s fees. While Medicare may cover inpatient hospital care in these cases, it will not cover any dental work that is specifically excluded from Original Medicare even if you are in the hospital.
Some Medicare Advantage Plans will cover the cost of routine dental services, but not every plan does. If you have a MA plan you will want to be sure to check with your plan to see what dental services, if any, are covered by the plan. In order to protect yourself from large out of pocket costs for dental care call and speak with one of our trusted agents to learn more about adding a dental plan to your Medicare.