When Does Medicare Cover Dental Services
Medicare Part A will cover emergency or complicated dental services you receive in the hospital. For instance, if you have an accident or have mouth cancer, Medicare may pay for surgery or tooth extraction necessary to treat your medical condition. Follow-up dental care, however, would not be covered.
Part B may pay for a dental exam that is required before you have a procedure done, like open-heart surgery. Original Medicare dental coverage for services like these are limited in nature and only apply to situations where you have an underlying health condition or procedure that must be supported by proper dental care.
Other dental services such as routine exams, teeth cleanings, fillings, dentures, and denture supplies are not covered by Original Medicare. Some Medicare Advantage Plans offer dental services as an additional benefit.
|Medicare Dental Coverage
|Covered as an additional benefit on many plans.
What You Should Know:
Medicare Advantage Plans, which are offered by private insurance companies, can cover services not covered by Original Medicare, including dental services, but not all plans provide the same coverage or at the same cost. For instance, one plan may cover cleanings only while others can provide more comprehensive benefits. Some may charge an additional premium for dental benefits.
The plans vary based on the state and county you live in and the benefits change each year, says Cynthia Pruemm, Investment Advisor, Founder and CEO of SIS Financial Group in Hoffman Estates, Illinois. It is important to not only compare benefits of the plan but also the value-added services that they offer, such as dental coverage.
Its worth researching and comparing plans before you join a Medicare Advantage Plan. There are three opportunities to join or switch to a plan that has dental coverage to meet your needs:
Best Medicare Dental Coverage For Seniors
The best dental insurance for most seniors is a Medicare Advantage plan from AARP/UnitedHealthcare because of its large network of dentists. We also recommend Aetna for low-cost dental coverage. If you need dental care right away, a stand-alone plan from Humana can provide comprehensive benefits starting the first day of coverage.
Recommended Reading: Is Kardiamobile Covered By Medicare
Original Medicare And Dental Coverage
Original Medicare consists of two parts, Part A and Part B . In general, neither parts cover routine dental care. One expectation in which you may be covered for dental services under Original Medicare is if you suffered a traumatic injury to the jaw, teeth, or mouth that required hospitalization. In this instance, you may be covered under Part A for any reconstructive surgery and for your hospital stay. For all other dental services like routine cleaning, extractions, fillings, etc. you will have to pay out of pocket.
Medicare Parts A And B
Medicare coverage is divided into two parts.
Part A is a hospital insurance program. If you are eligible, you can enroll without charge. However, if you are not covered by Social Security, you must pay part of the premium. When you apply for Social Security, you automatically apply for Medicare. However, if you apply for Medicare, you are not automatically applying for social security.
Part B is a medical insurance program covering charges from doctors, surgeons and other outpatient providers, as well as fees for medical supplies. If you are eligible for part A, you have the option of selecting supplemental part B coverage. To take advantage of part B, you must pay a monthly premium. In most cases, if you obtain routine care from out-of-network providers, neither Medicare nor a Medicare Advantage HMO plan will pay for the costs.
You do not have to be retired to enroll in Medicare. You are eligible for Medicare starting at age 65. When you apply for Medicare you are automatically eligible for both Part A and Part B. But even if you keep working after you turn 65, you should sign up for Medicare Part A. If you have health coverage through your employer or union, Part A may still help pay some of the expenses your group health plan does not cover.
Also Check: When To Sign Up For Medicare Part B
Medicare Advantage Plans & Dental Coverage
At Clover Health, we know how important dental care is to our members overall health. So we want to let you know which types of Medicare plans include preventive and comprehensive dental coverage. This page gives you an overview of the dental coverage offered with different types of Medicare plans and how Clover Health can expand your coverage to provide this essential benefit.
Medicare Advantage And Dental Coverage
The Medicare Advantage program offers you a way to get your Original Medicare benefits through a private, Medicare-approved insurance company.
Some Medicare Advantage plans cover routine dental services. Medicare Advantage dental coverage is generally the only way to get dental services covered under Medicare.
Don’t Miss: Can You Get Medicare If You Retire At 62
Which Types Of Medicare Plans Provide Dental Coverage
Some Medicare Advantage plans offer extra dental and vision benefits that Original Medicare doesnt cover. Medicare Advantage plans may offer basic coverage for dental services, which can include:
- Preventive dental exams
Usually, these types of Medicare Advantage plans will require you to visit an in-network dentist to be covered. These added dental benefits will vary by plan and most likely require deductibles and copays, so be sure to check out the details before you decide.
Does Medicare Have Hearing Benefits
Medicare wont cover hearing aids or exams for fitting a hearing aid because they dont consider hearing aids medically necessary. Also, Medicare doesnt cover hearing exams administered by an audiologist. Part B covers the service if your primary healthcare provider does the hearing exam during your Annual Wellness Visit.
Recommended Reading: Does Medicare Pay For Foot Care
What Is The Best Dental Insurance For Seniors On Medicare
Determining which dental insurance plan is best for you requires a consideration of your specific needs and preferences. It all boils down to what aspects of dental coverage are most important to you, be it the cost, network size or benefits that address specific dental issues that concern you most. Start by narrowing your plan options based on your geography and budget. Next, you can compare various plans customer satisfaction ratings, coverage limits and more. Its also worth researching the top dental insurance providers before enrolling in coverage.
What Does Medicare Cover Related To Dental Implants
There are other expenses related to dental implants, such as exams, x-rays to determine the state of your gums and teeth roots, and tooth extractions. If your MA plan has dental benefits, routine exams and x-rays are generally covered at least in part. Depending on your plan, tooth extractions may be partially covered as well. Crowns are sometimes covered, but if a plan excludes dental implants, the crowns associated with them are typically excluded as well.
The majority of dental implant procedures are done on an outpatient basis. Your MA dental plan may partially cover costs associated with the procedures, such as anesthetic or nitrous oxide.
The best way to determine if your MA plan with dental benefits pays for these other expenses related to dental implants is to talk directly to your dental provider/biller who works with insurance and understands which codes to apply to your claim.
If you have an MA plan that would pay for dentures as an alternative to implants, it is worth exploring whether or not some of those benefits could be applied to your dental implant costs.
Don’t Miss: How To Become A Medicare Broker
Does Medicare Supplement Insurance Include Dental Care
Medicare Supplement insurance is available from private insurance companies. It works alongside your Medicare Part A and Part B benefits and generally pays at least some of your Part A and Part B coinsurance, copayments, and deductibles.
Medicare Supplement insurance plans sold today donât include dental benefits with their standardized, basic benefits.
Read more about Medicare Supplement insurance.
Is Dental Covered By Medicare
A Medicare Advantage plan that includes dental benefits is the most common way of getting dental coverage while on Medicare. Original Medicare plans don’t cover dental care, but you can sign up for standalone dental insurance plan or get dental coverage through Medicaid if you qualify for dual enrollment.
Recommended Reading: How To Get Medicare Eob Online
How Much Does A Dental Bone Graft Cost
The costs of a dental bone graft can vary considerably. The complexity of the procedure and the material used are the two main factors influencing the cost.
When bone graft material comes from a cadaver, animal, or synthetic substance, the cost can vary between $400 and $1,200. If bone material is harvested from your own body, the cost may jump to $2,000 or more.
Many insurance providers, including Medicare, dont cover dental bone grafts in most circumstances.
If your doctor determines that the procedure is medically necessary, your insurer may cover part of the procedure. If the grafting is for cosmetic reasons, its unlikely youll receive any insurance assistance.
Also Check: Is There A Copay For Doctor Visits With Medicare
Does Medicare Part D Cover Dental
When it comes to Medicare, it can be confusing to know whats covered and whats not under each part. While Original Medicare provides basic coverage, it lacks in providing coverage for much-needed services like dental care. This can catch many new beneficiaries off guard. For those concerned about dental coverage, you may be wondering what options you have when it comes to Medicare. Lets take a look at what Medicare covers when it comes to dental care and how you can get the coverage you need.
Recommended Reading: Why Is Medicare Advantage Growing
Ways To Get Dental Coverage On Medicare
Dental health affects more than just your teeth. In fact, Harvard Health notes that those with gum disease have an increased risk of heart attack, stroke, and other serious cardiovascular health events. Yet Original Medicare does not cover routine dental care, dental implants, or fillings. But that doesnât mean that dental care is completely out of the question. These options can help you get the dental coverage you need while on Medicare.
S For Getting Dental Implants
The process for getting dental implants takes place over several stages each of which is billed as a distinct procedure. The process begins with an initial consultation or evaluation to determine the best course of action. In subsequent visits, the doctor will place the implant, followed by the abutment, and finally the replacement crown. Placing the crown is the final step and signifies the dental implant is complete.
Don’t Miss: Can I Print My New Medicare Card Online
Choose A Medicare Advantage Plan
Some Medicare Advantage plans include benefits like routine dental, vision and prescription drug coverage. There are quite a few plans to choose from, with a wide range of premiums and coverage options.
Be sure to consider your current and future needs. For example, if you have dentures or think you may need them in the future, look for a Medicare Advantage plan that covers dentures.
Compare Medicare Advantage Dental Plans
Using Medicares Find a Medicare Plan tool, you can log in without an account, choose a Medicare Advantage Plan, type in your ZIP code, and follow the simple instructions to get a list of the available plans. The Plan Details button helps you learn more about the coverage offered, such as preventative dental or comprehensive dental .
Recommended Reading: Can You Qualify For Medicare Through Your Spouse
Medicare Advantage Plans With Dental Care Benefits
Another option for Medicare beneficiaries is to enroll in a Medicare Advantage plan that offers routine dental care coverage.
A Medicare Advantage plan provides all the same coverage as Original Medicare .
In addition to covering the same benefits as Original Medicare, some Medicare Advantage plans may offer additional benefits such as:
- Prescription drug coverage
The dental coverage afforded by some Medicare Advantage plans can provide patients with benefits such as access to networks of qualified dentists while offering price protection in the form of deductibles, cost-sharing measures and out-of-pocket spending limits.
Plus, many Medicare Advantage plans also offer coverage for prescription drugs, so some of the medications needed for oral care may be covered under the plan as well.
When you consider the annual costs of receiving dental care without insurance, you may find that a Medicare Advantage plan with dental benefits could fit your situation and health care needs.
Does Medicare Cover Vision Care
Vision care is not seen as medically necessary, so Original Medicare doesnt cover eye exams, eyeglasses or other related vision services.
However, Medicare Part B may cover some things for vision including preventive or diagnostic eye exams, including glaucoma tests, yearly eye exams to test for diabetic retinopathy and eye tests for macular degeneration, cataract surgery and prescription lenses or eyeglasses in certain situations.
But fear not, you have options if you have Medicare and want some help with the cost of dental and vision care. Learn how to get dental, vision and hearing care covered when choosing Medicare in the video below.
Read Also: Will Medicare Cover A Lift Chair
Does Medicare Cover Diabetic Retinopathy
Those with diabetes carry the risk of developing diabetic retinopathy, which is a complication of diabetes that damages blood vessels in the retina and affects vision.
An annual exam for diabetic retinopathy can be covered by Medicare Part B if you have diabetes.
If qualified for any of the above coverage, you will pay 20 percent Part B coinsurance for services and items and the Part B annual deductible applies.
Does Medicare Cover Glaucoma Screenings
An annual glaucoma test may be covered by Medicare Part B if you are at a high risk of glaucoma due to having diabetes, a family history of the disease, Hispanic and age 65 and older or African American and age 50 and older.
Glaucoma is a condition that causes damage to the optic nerve and can lead to permanent vision loss if left untreated.
Don’t Miss: Are Medicare Advantage Plans Hmos
Do All Medicare Advantage Plans Cover Dental Services
No â although many Medicare Advantage plans cover routine dental care, not all do. That� � âs why it may be a good idea for you to compare Medicare Advantage plans. That way, you can see which Medicare Advantage plans cover dental services and other benefits that are important to you. For example, if routine vision and hearing care are important to you, you can look for such coverage when you compare plans.
One easy and quick way to compare Medicare Advantage plans â with no obligation to enroll â is to use eHealthâs plan comparison tool. All you need to do to get started is enter your zip code on this page.
You may have to pay a deductible and/or coinsurance or copayment for these services in Medicare Advantage plans with dental coverage.
Itâs important to keep in mind that Medicare Advantage plans are offered by private insurance companies contracted with Medicare. These private insurance companies must cover everything that Original Medicare covers, and might offer additional coverage as well. Routine dental services would be considered additional coverage.
Medicare Advantage dental services may vary from plan to plan. As you browse through Medicare Advantage plan descriptions, look under the âdental servicesâ section. If it says âMedicare-covered benefitsâ you may not get any coverage beyond what Original Medicare covers, which does not include routine care.
Best Medicare Advantage Dental Plans
What is the best dental insurance plan? Original Medicare does not cover dental services like cleaning, fillets or extractions. In order to obtain dental care seniors can either buy a separate plan or use an insurance plan that provides some type of cost support. Medicare Advantage is a bundled alternative to original Medicare sold from privately held insurers. It includes Medicare Part B and Part A and most frequently Part D benefits.
Read Also: How Does Medicare Work With Other Insurance
How Much Is A Dental Bone Graft
The costs for bone grafts vary depending on your individual needs. Your dentist will do a thorough clinical assessment to determine the specific treatment you need before you start any treatment. They will talk you through the exact costs when you see them for your initial consultation, and youll be able to ask any questions you may have.
Also Check: Does Medicare Cover Laser Surgery
Characteristics Of Dental Insurance Plans
Dental insurance plans are constructed differently than most health-related insurance. Below are some of the characteristics of dental insurance that are common amongst the most popular plans. Keep in mind that there are literally hundreds of different dental plans or dental, vision and hearing plans available. What we have done sought out those that provide the best value for our Medicare clients.
Also Check: When To Apply For Medicare When Turning 65
Medicare Beneficiaries And Dental Care
New research produced by the Kaiser Family Foundation revealed some eye-opening facts about the nearly 60 million Medicare beneficiaries and their overall lack of dental insurance coverage.
According to KFF, 65 percent of Medicare beneficiaries do not have any dental coverage.4
Some of the key findings of the KFF study include:
- Almost half of Medicare beneficiaries did not visit a dentist in the past year.
- Of the beneficiaries who did visit a dentist in the last year, 19 percent paid more than $1,000 in out-of-pocket dental costs.
- 15 percent of Medicare beneficiaries have no natural teeth.
Because Original Medicare does not provide coverage for routine dental care, many Medicare beneficiaries may choose to join a Medicare Advantage plan that includes dental benefits.
Some Medicare beneficiaries may also decide to buy a separate dental policy or pay entirely out of pocket for their dental care.