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Medicare & Dental Work

As we age, dental care becomes an increasingly important concern, and according to Medical News Today, many elderly Americans avoid the dentist due to the cost. Medicare, the federally administered health care program for elderly and disabled Americans, offers very limited dental services. Though in some rare instances care will be covered, most beneficiaries will have to find care another way.

  1. Routine Dental Care

    • Original Medicare does not cover dental care that is needed only for dental health. This includes cleanings, routine checkups and fillings. Furthermore, original Medicare does not cover dentures in any instance, even if teeth must be extracted for another medical procedure and that extraction was covered by Medicare.

    Medically Necessary Care

    • Original Medicare will cover dental services in the case that the service is required in order to protect the beneficiary's overall health. For example, Medicare will cover extractions of teeth that are infected when the infection is at risk of spreading. However, Medicare will not cover any follow-up care after the risk to the overall health of the beneficiary is eliminated.

    Dental Hospitalizations

    • If a beneficiary requires hospitalization due to either developing an infection after an extraction or she has a life threatening health condition which means she requires observation during any dental services, Medicare may cover some of the expenses. Some of these expenses include the room and board and anesthesia. However, Medicare will not cover any of the dental costs such as physician or anesthesiologist fees.

    Other Covered Dental Care

    • The only other instance in which Medicare will cover dental services is when extractions or other services are needed in order to successfully complete other medically necessary services. This includes any extractions required to perform a surgery to treat any cancers or fractures in the jaw or face. Medicare will not cover any follow-up care after the extractions, unless it becomes infected.

    Medicare Advantage

    • Some Medicare private health plans, also known as Medicare Advantage plans, may opt to include routine dental services in their coverage. Beneficiaries should contact the Medicare private health plan directly to see if dental services are covered.

    Alternatives to Medicare

    • Often times, insurance that supplements Medicare, such as Medicaid and retiree insurance, offers dental services. Medicare recipients can access these services through the supplemental insurance, but are subject to whatever coinsurances the supplemental insurance will charge. Medigaps, however, do not offer any dental insurance. Many Medicare beneficiaries also turn to reduced cost clinics, hospitals and dental schools.

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