Medically Necessary Dental Services
From the outset, the Medicare program has excluded coverage for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth of the Social Security Act). The 1965 legislation authorizing the program provided a narrow exception that payment could be made in the case of inpatient hospital services in connection with the provision of dental services if the individual, because of his/her underlying medical condition and clinical status, or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.
summarizes Medicare’s limited coverage of dental services. The summary is based on HCFA policy statements rather than on sometimes conflicting carrier policies.
Medicare Coverage of Dental Services as Specified in Statute or by the Health Care Financing Administration.
Neither the statutory nor the regulatory language related to coverage exceptions for dental services is straightforward to interpret. Moreover, carrier interpretation is not always consistent. For example, at least one carrier’s policies appear to approve coverage for an oral examination not only for kidney transplant patients but also for heart, liver, and other covered organ transplants, whether performed on an outpatient or an inpatient basis .
Effectiveness Of Dental Care In Improving Health Outcomes For Leukemia And Lymphoma Patients
No large, multicenter, randomized clinical trials have assessed the effectiveness of dental interventions to prevent or manage oral or systemic complications of chemotherapy for leukemia or lymphoma patients. A few controlled studies suggest that dental care for leukemia patients prior to chemotherapy may prevent or reduce subsequent episodes of septicemia and prevent or reduce the severity of common oral complications of chemotherapy that are associated with the prior burden of oral disease . Unfortunately, these studies involve few elderly patients.
A recent study with no control group that tested the effect of not treating chronic dental disease prior to chemotherapy concluded that treatment for chronic problems could be safely postponed with little effect on the subsequent risk of acute dental disease . It also concluded that a prechemotherapy oral examination was still needed to identify acute dental disease for treatment to prevent local exacerbations or systemic spread of infection
These few studies of prechemotherapy dental treatment have involved mostly or entirely leukemia patients, who tend to receive aggressive, combination chemotherapy that is associated with more severe immunosuppression. Additional studies would be needed to determine the effects of prechemotherapy dental treatment on lymphoma patients.
Alternatives To Medicaid Denture Coverage
There are alternative methods to acquire financial help if you reside in a state that does not provide dentures as part of Medicaid benefits.
Dental Insurance
Signing up for a dental insurance plan is one option. Private insurance providers offer family and individual policies and often cover dentures.
Be careful to read the policy description to learn all the specifics of your plan since the premiums, deductibles, and coinsurance amounts will differ across the plans.
There are numerous dental plans in the US that cover dentures or partial dentures.
You can visit Dentalinsurance.com to find the best dental insurance plans in your state. By just entering your zip code and birthday, you may see the most popular options in your area.
Discounts for seniors on dentures
Last but not least, inquire about any senior discounts offered by your local dental office. If they don’t provide a senior discount, they could charge you less if you pay in advance or with cash or a check. Additionally, many dental offices offer third-party financing, often with 0% interest for a short time.
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Best Online Tools: Humana
Humana is our top pick for a dental plan with robust online tools. It has a handy mobile app that allows users to list medications, view claims, and even earn rewards for healthy actions.
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Robust selection of helpful online tools
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SilverSneakers fitness program
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Website interface can be confusing
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Not all plans come with dental coverage
Humana offers a wide variety of online tools helpful to Medicare Advantage Plan enrollees. Humanas RXMentor helps enrollees keep a complete, up-to-date list of their medications. Their MyHumana app offers access to ID Cards, drug pricing, claims, and in-network providers. Their Go365 program and app allow you to earn, track, and redeem points for completing healthy actions. Both the app and Go365 are accessed using two-factor authentication to keep your accounts secure. These are the kinds of useful website features that made Humana our pick for the best online tools.
Humana also offers SilverSneakers, a health and fitness program for seniors that includes gym access, classes, and the SilverSneakers Go fitness app for tracking and scheduling activities.
Founded in 1961, Humana offers a full range of Medicare Advantage plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
How To Sign Up For Supplemental Medicare
Supplemental Medicare plans dont have open enrollment periods like traditional Medicare does. Those eligible can sign up for plans at any time.
Use Medicares Plan Finder to locate supplemental plans in the desired area. Some applicants may be able to sign up online through the plans website. If that is not possible, they can contact the plan provider for a paper enrollment form, fill it out and return it to the plan provider. All plans offer a paper enrollment option. The plans provider will ask for a Medicare number and the date the Part A or Part B coverage started, which is found on the Medicaid card.
Once an individual finds a suitable plan, they can call the provider for more information. Those with more general questions can call Medicare at 1-800-MEDICARE .
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Do Any Medicare Plans Cover Dentures
Original Medicare Medicare Part A and Part B typically does not cover dentures or other dental services.
Some Medicare Advantage plans and other Medicare-related insurance or savings plans may offer options to help pay for dentures or other dental services.
Medicare Plans and Denture CoverageDon’t Leave Your Health to Chance
What Medicare Plan Covers Dentures
Medicare Part C plans offer additional services such as dental coverage to encourage members to choose their plan. The ability to gain coverage for both Medicare Parts A and B and additional options Original Medicare does not provide can make Medicare Advantage plans very advantageous for some people.
However, its important to read a Medicare Advantage policy carefully. Companies may structure their policies in several different ways. For example, some dental policies cover only preventive treatments, like annual cleanings or X-rays.
Medicare Advantage policies that cover restorative treatments may offer coverage for dentures. Insurance companies consider restorative treatments as those that can help restore your smile. These include crown placements, dental bonding and dentures.
Medicare Part C policies for dental coverage are truly varied. Often, to obtain dental benefits that extend to restorative services such as dentures, you will pay a monthly premium for your Medicare Part C plan, according to KFF.
Are you eligible for cost-saving Medicare subsidies?
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Current Sources Of Dental Coverage
Since its establishment in 1965, Medicare has explicitly excluded coverage for dental services, except in very limited circumstances.48 Traditional Medicare does not cover routine preventive dental services , nor minor and major restorative services .
Figure 6: Medicare covers limited dental services
Medicare coverage is limited to dental services that are an integral part of a covered procedure, extractions done in preparation for radiation treatment for cancers involving the jaw, and oral examinations preceding kidney transplants or heart valve replacements.49 Medicare also covers hospital care resulting from complications of a dental procedure, but does not cover the cost of the dental care itself.50 Current coverage policy for dental care is not completely clear or consistent, and the Medicare program is reviewing its authority to provide additional services.51
Nearly 37 million people, or almost two in three Medicare beneficiaries , do not have any form of dental coverage . Beneficiaries without any form of dental coverage are more likely than others to go without needed dental care, unless they can afford to cover the costs out-of-pocket.52,53
Figure 7: Almost two-thirds of all people on Medicare have no dental coverage
Scope of Coverage
In the following sections, we review current sources of dental coverage that may be available to people on Medicare, including Medicare Advantage, Medicaid, and private dental plans .
MEDICARE ADVANTAGE
MEDICAID
PRIVATE INSURANCE
Assessment Approach: Intervention Population And Outcomes
The selection of conditions and services for assessment was guided in part by historical context. A few months before the passage of the 1997 Balanced Budget Act, legislation had been introduced, first, to cover a specific set of medically necessary dental services that were described as cost-effective and, more generally, to provide for future coverage of other services subsequently determined to result in reductions in expendituresthat exceed expenditures resulting from such coverage . This latter requirement is quite stringent generally, services are considered to be cost-effective whether or not they produce cost savings that fully offset direct service costs. The more restrictive language reflects the rules that Congress has adopted requiring increases in spending in one area to be offset by cuts elsewhere or by increased taxes.
The five conditions listed in the 1997 bill had been presented in prior analyses of health conditions that sought to identify those for which the cost of covering inpatient dental services would likely be offset by savings related to complications avoided, especially additional hospitalization . The five conditions were
- 1.
- 5.
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valvular heart disease.
The population of interest includes Medicare beneficiaries age 65 and over as well as younger people qualified for Medicare on grounds of disability or diagnosis of end-stage renal disease . Evidence related to all age groups was reviewed.
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There Are Different Types Of Dentures
Before you consider whether to get dental coverage through Medicare Advantage or a private insurer, it helps to understand a few basics about dentures.
Partial versus full dentures: Partial dentures are recommended when you have enough healthy teeth in the correct positions to anchor a dental appliance. Full dentures replace all upper and/or lower teeth.
Removable versus implant dentures: You take out removable dentures each night to clean them. Implant dentures are installed permanently with surgery that embeds them in your jaw. Removable dentures are typically much less expensive than implant dentures.
Ask a dentist or prosthodontist to evaluate your potential need for dentures and to estimate the cost, which will help you decide on a Medicare Advantage plan or private dental insurance.
Does Original Medicare Part A And Part B Cover Dental
Original Medicare doesnt cover most dental care, dental procedures or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates or other dental devices.
Although Original Medicare doesnt cover the type of care youd get in a dentists office, Medicare Part A will pay for certain dental services that you get when youre in a hospital. You may get coverage for some dental treatments that are part of another Medicare-covered service, or dental care designed to protect your overall health. For example, Medicare may help pay for oral exams before a surgery or dental services related to radiation treatment. It may also pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isnt covered.
But if you simply have a toothache thats driving you crazy, youll have to pay out of pocket to see a dentist. However, you could get dental coverage through some Medicare Advantage plans.
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Does Medicare Advantage Cover Dentures
The good news is, yes. Most Medicare Advantage plans provide dental coverage. Some pay only for routine dental care while others allow for more extensive dental services, including the potential for dentures.
In 2021, 76 percent of people in Medicare Advantage plans that covered extensive dental services had coverage for periodontics or prosthodontics, according to a Kaiser Family Foundation study. Periodontics is the prevention and treatment of gum and tooth diseases. Prosthodontics is the branch of dentistry that specializes in making replacements for missing or damaged teeth, and that may include dentures, dental bridges, implants and other false teeth.
Typically, plans that cover dentures generally limit coverage to one set every five years. But cost sharing, meaning what you pay out of pocket and what insurance covers, varies widely. In 2021, plans that charged a fixed-dollar copayment ranged from $0 to $500, while plans that charged coinsurance, which is a percentage of the cost, typically charged members 50 percent to 70 percent of the cost for in-network providers.
Most plans put annual caps on extensive dental services, averaging $1,300 in 2021, but 8 percent of the plans had a coverage cap of $2,000 to $5,000. This cap usually didnt apply to routine and preventive dental care.
With such a wide range of coverage levels, its important to research how each plan covers dentures.
Services Excluded Under Part B
The following two categories of services are excluded from coverage:
A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw.
A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth .
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Best Customer Service: Kaiser Permanente
Kaiser Permanente
We chose Kaiser Permanente for its excellent customer service. Kaiser garners top scores in customer satisfaction from J.D. Power.
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Coverage available at any Kaiser Permanente facility
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Flexible premiums
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Only available in 8 states
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Some dental coverage can cost extra
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In some plans, dental is bundled with hearing and vision coverage
Kaiser gets our nod for best customer service based on their ratings from Medicare and from J.D. Power, the data analytics and consumer intelligence company. Kaiser came in first place in J.D. Power’s Medicare Advantage customer satisfaction study six times in the last seven years. Founded in 1945, Kaiser Permanente is based in Oakland, Calif. and serves 12.6 million members. People enrolled in Kaisers Medicare Advantage plan can get coverage at any Kaiser Permanente facility, and premiums range from $0 to over $100 each month, depending on your needs and where you live.
With many of their Medicare Advantage Plans, Kaiser offers the Silver& Fit senior fitness program. The program is offered with a facility-based option and a home-based option and includes educational materials on healthy aging, social activities, and an activity and exercise tracking tool.
Why Doesnt Original Medicare Cover Dental
Medicares key coverage points have changed very little since the program was established in 1965. Why dental coverage wasnt included in the original package is a matter of debate, but introducing it now would require an enormous political effort and financial investment.
The American Dental Association has also consistently opposed the idea of bundling dental coverage into Original Medicare, citing the threat of lower pay.
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Why Is Medicare Part B Cheaper In 2023
The Centers for Medicare and Medicaid Services recommended in May that any excess Supplementary Medical Insurance Trust Fund money be passed along to those with Medicare Part B coverage. This is to help decrease the costs of the premium and deductibles. While most Medicare recipients get Part A for free, everyone has to pay for Part B.
This years Part B premium was projected to cover spending for a new drug called Aduhelm, which is intended to treat Alzheimers disease. Since less money was spent on that drug and other Part B items, there were more reserves left over in the Part B account of the SMI fund, which will now be used to limit future Part B premium increases.
Medicare Part A premiums will rise a little in 2023.
Best Dental Insurance For Seniors On Medicare Of 2022
- Best Customer Service: Kaiser Permanente
- Best Online Tools: Humana
- Best for Potential New Offerings: WellCare
- Best for Special Needs: Cigna
- Coverage Limit : $1,000 to $2,500
- Providers In Network: 1,300,000
United Healthcare is our top overall pick for dental insurance for seniors on Medicare. It offers Medicare Advantage plans with an expansive network and flexible premiums.
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Limited plan options depending on your location
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Not all Advantage plans include dental coverage
United Healthcare, founded in 1977, was chosen as the best overall based on its popularity and its affiliation with the American Association of Retired People . In 2021, 26 million people were enrolled in Medicare Advantage plans nationwide. Of those 26 million people, United Healthcare insured the largest share of them, 27%.
Although United Healthcare was ranked below average for overall customer satisfaction in a 2021 J.D. Power study , more than 74% of Medicare beneficiaries have access to at least one United Healthcare plan in 2022.
Their full range of plans has premiums ranging from $0 to over $100 each month, depending on your needs and location. If you choose United Healthcare, you’ll also receive access to additional AARP programs and services such as discounts on shopping and travel, savings on home and auto insurance, and free financial advice.
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