Does Medicare cover dental care services or dentures?
Unfortunately, Medicare’s dental health benefits are next to none. Neither routine dental care, nor other dental procedures such as teeth cleaning, fillings, extractions, crowns, bridges or dentures are covered by original Medicare.
There are some rare exceptions, when Medicare Part A (Inpatient Hospital Insurance) would cover specific dental procedures as an integral part of another covered procedure. Those procedures must usually be performed inside the hospital and may – under specific circumstances – include e.g. reconstruction of the jaw in case of an accident, or necessary tooth extractions in preparation of a radiation treatment.
Even if a dental emergency requires that a person is admitted to a hospital – although Medicare Part A will cover the hospital stay – it won’t pay for the dental procedure.
This means, Medicare beneficiaries need to pay for 100% of their dental services, if they don’t have any coverage outside of traditional Medicare.
How Can I Get Dental Coverage With Medicare?
If you are on Medicare and don’t want to be responsible for your dental care costs, you have different options:
1. Medicare Advantage Plans With Add-On Dental Coverage – Medicare Supplement Plans With Add-On Dental Coverage
Medicare advantage and supplemental plans are run by private insurance companies in compliance with federal guidelines.
Many insurance providers offering Medicare advantage plans or supplemental insurance, also offer optional dental benefits for their members. Dental coverage is usually provided in a separate policy and requires an additional monthly premium, with co-payments for office visits and deductibles for major services, plus a ‘cap’ on the maximum of benefits you may receive during the year.
Where available, beneficiaries may add these benefits to their advantage or supplemental plan at the time they enroll or at any time throughout the year. Dental insurance are usually HMO or PPO or PPF (private fee for service), which means you have to select a primary care dentist who is participating in the plan’s network of providers to be fully covered. If you select an out-of-network dental professional, you have to pay more for the same service.
Dental benefits depend on the plan, and many insurers offer different levels of coverage. Depending on the plan, basic and preventive dental care such as teeth cleaning, fillings, X-rays and minor denture adjustments is covered to a certain amount up to 100%, while major procedures such as dentures, crowns, or bridges, root canals or oral surgery, are usually only partially covered and require a co-payment or deductible.
Benefits and costs vary widely among insurance companies, so make sure you compare, before you enroll! Also make sure to always read all correspondence you receive from your insurer, as your benefits may change on January 1 of each year!
Check with the provider of your Medicare advantage or Medigap policy for more information on available dental insurance plans.
2. Dental Insurance
Although typically the conditions for an ‘add-on’ dental to your Medicare plan are supposed to be more favorable to you, you may also check out dental insurance policies that are offered by different, independent insurance providers. These dental insurance policies generally work the same way: As member of a HMO or PPO insurance, you have to select your dental service provider from the plan’s network, and you are responsible for all charges incurred after your plan has paid the amounts for covered dental services.
If your spouse is still working, you may also have group dental insurance available to you.
3. Dental Discount Programs – Dental Plans – Dental Discount Cards
You will also find organizations offering dental discount cards, also referred to as ‘dental discount programs’ or ‘dental plans’. Being a member of such a program or organization means you have to pay an annual fee in order to get access to a network of participating dental professionals who have agreed on discounted rates for their services. Dental plans are no insurance and you will have to pay the dentist for your services at the time of service.
Make sure to compare benefits, annual fee and any regulations or limitations of the plan, and check out how large the number of participating professionals of the network is, before you subscribe! Compared to dental insurance, the advantage of dental plans are typically that there is no waiting period for services, and you will also get a discount on major procedures and prosthetics.
4. Dental Help Programs For Qualifying Persons
Medicaid
Depending on the state you reside in and your income, Medicaid may cover part or all of your dental services. Check with your local Medicaid office to see whether you are covered.
Community Health Centers
Community Health Centers are funded by the Health Resources and Services Administration (HRSA), providing free or reduced-cost health services, including dental care, to qualifying persons in many local areas.
