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Dental Coverage under Medicare
Original Medicare typically does not include routine dental benefits, such as dental exams, cleanings, fillings, crowns and bridges. These are not covered benefits under Medicare.
Routine Dental services have never been a part of Original Medicare coverage even since Medicare began. However, in 1980, a Medicare amendment was created to allow Medicare coverage of inpatient hospital services for dental procedures that make hospitalization necessary.
- For an accident that resulted in damage to the jaw, Medicare would cover the medical reconstruction of the jaw.
- If you have a disease involving the jaw, Medicare might cover a dental tooth extraction that is directly caused by the disease.
- For emergency and complicated dental procedures that require a hospital stay, Medicare Part A would cover the hospital stay, but Medicare would not cover the dental procedure.
- If you're about to have a kidney or heart transplant or other complicated procedure that requires a preliminary dental exam, Medicare will cover the dental exam either under Medicare Part A or Medicare Part B, depending on whether the dental exam was performed by hospital staff or an in-office physician.
How Medicare recipients can get dental coverage
Since routine dental coverage is not available under Original Medicare, you are generally responsible for the full amount of your dental care unless you have other dental insurance. Here are a few suggested dental options for Medicare recipients:
You can purchase independent dental coverage. You can shop online at www.ehealthinsurance.com to learn about and buy an individual dental insurance plan. Or, you may have group dental insurance available to you if you or your spouse are employed. Be sure to read the plan designs carefully and select a dental plan that appeals to you. Some dental plans require you to stay within a network of dental care providers. This is especially good if your current dental care provider is in the plan's network. The premiums may be a bit higher for this type of dental plan, but are offset by lower out-of-pocket costs like co-pays, coinsurance and deductibles. That's because network dentists usually agree to charge discounted rates to members of the dental plan. Other plans allow you to go to any licensed dental professional, but you may pay more at the time of service.
Medicare Advantage plan with dental coverage - Some Medicare Advantage plans include dental coverage. Medicare Advantage (also known as Medicare Part C) can include extras like routine vision, routine dental and Medicare prescription drug coverage. Make sure your Medicare Advantage plan includes coverage for all your health care needs. You can check out Medicare Advantage plans in your area by visiting a website such as www.planprescriber.com or other similar websites
Dental discount cards - Some dental care provider organizations offer dental discount cards. This is neither Medicare nor dental insurance and there are no dental benefits payable to you or the dentist. You pay the total cost of your dental care. However, with a dental discount card, you get access to a network of dental professionals who agree to discounted rates for dental exams, cleanings, fillings and more. You pay one annual fee to be in the program and just use it when you receive dental care. You can ask your dental care provider if he or she offers a dental discount program.
Medicare has neither reviewed nor endorsed this information.