Medicare

It might come as a surprise to learn that Medicare doesn’t provide coverage for most dental procedures. This means that anyone who relies on Medicare Part A or B for their healthcare could be left paying out of pocket after undergoing a dental procedure. We’ll take you through what’s covered under Medicare, what’s not, and what your alternative options are:

Does my risk of dental problems increase as I age?

As you get older, it becomes easier to neglect your oral health:

• Gum disease is painless, which means that it’s often left undetected until it’s too late.
• Oral cancer afflicts a far greater proportion of old people. The average age of people who are diagnosed with this form of cancer is 62 years old.
• Your exposure to cavities may increase as you get older. They’re often caused by dry mouth, a side-effect of many modern medications.
• Tooth loss and tooth decay become more common as people get older.

This means that as you age, dental coverage is a critical part of protecting your overall physical health.

What services aren’t covered by Medicare?

So, which dental procedures aren’t covered by Medicare?

• Routine dental care, including cleaning, fillings, crowns, bridges, and dentures.
• Dentures (either complete or partial).
• Dental exams.

What dental services does Medicare cover?

Now, let’s explore the dental services which are covered under Medicare. Essentially, if you need dental care to protect your general health, or if a medical procedure is dependent on dental care to be successful, Medicare will cover it.

So, in which situations would Medicare cover your dental health?

• If you need dental splints or wiring after having jaw surgery.
• If you have a jaw disease (i.e. oral cancer) and need dental surgery before you’re able to get radiation treatment.
• If you had ridge reconstruction following treatment for a facial tumor.
• If you have a jaw or facial fracture and require dental surgery to treat your injuries.

Remember, even if Medicare does pay for these dental procedures, it won’t provide coverage for any follow-up care that you might require. You will need to pay the entire cost of the follow-up treatment yourself.

However, Medicare will provide coverage for some hospitalizations arising from dental health. For example:

• If you get an infection after having a tooth pulled.
• If you have a health condition which requires you to be held under observation during a dental procedure.

In these situations, Medicare will cover the costs of your hospitalization (room and board, x-rays, and anesthesia), although you’ll still have to pay the fees incurred by your dental treatment.

What’s covered by Medicare Advantage (Part C)?

If you’re enrolled in a Medicare Advantage plan (a type of Medicare health plan offered by private companies), your dental care options are much more extensive. Many Medicare Advantage plans cover basic dental services, such as x-rays, oral exams, cleanings, and fillings, along with major services such as crowns, tooth extractions, and oral surgery. However, coverage does vary from plan to plan, so it’s best to check to see exactly which services are available.

What can you do if your dental procedures aren’t covered?

So, what are your options when Medicare won’t pay for your dental care and you don’t have a Medicare Advantage plan?

• Medicaid: In certain states, Medicaid will cover dental care. If you have a low income or few assets, you may qualify for coverage.
• Dental schools: Some dental schools will provide affordable, high-quality care.
• Community health centers: You may be able to get reduced-cost dental care (as well as other healthcare services) at a community center.
• Free clinics: You may be able to get reduced-cost dental care at a local dental clinic.
• Dental insurance: If you don’t want to take the risk of being left without coverage, it’s probably worth purchasing a dental plan. There are plenty of affordable options available to choose from.