Does Medicare Cover Dental Health
En español | Original Medicare has no dental plan. It does not cover most routine dental services such as exams, cleanings and X-rays procedures related to dental health, such as fillings, extractions and root canals or dentures and other dental devices.
However, original Medicare can pay some costs associated with emergency or medically necessary dental care.
For example, Medicare Part A, which includes hospital insurance, could cover having teeth pulled in preparation for radiation treatment of jaw cancer, or inpatient care if you need a complicated or emergency dental procedure while in the hospital, such as jaw reconstruction after an accident.
If you rely on Medicare and want coverage for regular oral care, look into Medicare Advantage plans. These policies, offered by private insurance companies, include all original Medicare coverage and often have extra benefits such as dental services .
Another option is Medicare Supplemental Insurance, better known as Medigap. These plans, also sold by private insurers, cover some out-of-pocket costs for Medicare treatment. They do not specifically include extra benefits, but some Medigap providers offer clients options for dental coverage, or discounts on out-of-pocket costs for oral care. If you have Medigap, ask if your provider offers related dental benefits.
Editor’s note: This article was originally published on July 15, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.
Medicare And A Lack Of Dental Coverage
Unfortunately, having Medicare doesnt always help with this issue. According to Medicare.gov, this federal health insurance program typically does not cover dental care, procedures, or supplies.
Medicare doesnt provide benefits toward regular cleanings or services designed to treat and/or correct problematic oral issues, such as fillings or tooth extractions.
Medicare also does not generally offer benefits for dental devices, including dentures and dental plates.
So, what does Medicare cover when it comes to dental health care?
Medicare will also contribute toward oral examinations needed before kidney transplants or heart valve replacements in certain situations.
Biden Says Expanding Medicare To Include Hearing Dental And Vision A ‘reach’
Joe BidenBiden slams Nicaragua’s ‘sham elections,’ calls Ortegas autocratsAmtrak chief outlines expansion plans with infrastructure spendingFormer Goldman Sachs boss weighs in on infrastructure vote: ‘Progressives blinked’MORE said Thursday that expanding Medicare to include hearing, dental and vision benefits would be a reach amid ongoing negotiations with Democrats over his sweeping economic agenda.
During a CNN town hall, Biden told anchor Anderson Cooper that Sens. Joe ManchinKyrsten SinemaTrump to attend fundraiser for Arizona GOP Senate candidateOn The Money Presented by Citi A House divided on a unified agendaShowdown: Pelosi dares liberals to sink infrastructure billMORE two key moderates at the center of ongoing negotiations about how to scale back Democrats reconciliation bill are opposed to the expansion.
Thats a reach and the reason why its a reach I think its a good idea and its not that costly in relative terms especially if you allow Medicare to negotiate drug prices, Biden said. But heres the thing Mr. Manchin is opposed to that as is, I think, Sen. Sinema.
Biden explained Manchins opposition by saying he doesnt want to further burden Medicare because it will run out of its ability to maintain itself in X number of years.
Look, Joes not a bad guy. Hes a friend and hes always at the end of the day come around and voted, Biden said.
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Dental Coverage For Medicare Recipients Divides Parties
Lawmakers are split along party lines on a proposal to include dental coverage for all Medicare recipients included in Democrats $3.5 trillion reconciliation package.
Speaking at The Hills Future of Medicare and Oral Health event on Wednesday, Rep. Nanette Diaz Barragán called dental care a crucial part of health care and not a luxury.
There is a lot of support for providing dental coverage. Unfortunately, depending on who you talk to, it comes down to a conversation on cost. Can we afford it? Barragán, a member of the Congressional Progressive Caucus, told The Hills Steve Clemons.
Part of the problem in the United States is we focus too much on being reactionary. Instead of preventive care thats gonna save us money in the long run it comes down to cost, added Barragán, who introduced the Medicare Dental Benefit Act of 2021 thats slated to be part of the $3.5 trillion reconciliation bill in the House.
.: unfortunately depending on who youre talking to, it comes down to a conversation on cost…we focus too much on being reactionary instead of preventive care thats going to save us money in the long run#TheHillMedicare
The Hill Events
Barragán, whose congressional district is among the poorest in the state, said that the Medicare Dental Benefit Act would improve quality of life for many of her constituents.
Does Part C Cover Dental
Some Advantage plans include dental insurance, and others dont. Coverage can vary. Some plans cover only standard services, and others cover a wide range of dental procedures. Research plans, so you understand whats included before signing up. Advantage plans often include vision and hearing benefits as well.
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Does Medicare Cover Invisible Aligners
Invisible aligners like Smile Direct Club help straighten teeth but arent as noticeable as braces. Medicare wont cover invisible aligners. But, some insurance companies usually treat aligners the same as braces. If your dental insurance includes orthodontic work, it will typically cover aligners.
With that said, it may be hard to find insurance that includes adult orthodontic coverage. If you do, you can expect to pay a percentage of the cost. Another option is to buy into a dental discount program that offers a discount on aligners.
Table 42summary Of Dental Services Currently Covered And Not Covered Under Medicare For Selected Diseases Or Conditions
|Management of infection following transplantationOral examination prior to renal transplant surgery on an inpatient basis||Oral examination for transplants other than kidneyOutpatient oral examination performed by a dentist prior to kidney transplantDental treatment to reduce risk of infection or eliminate infection for any transplantation prior to or following transplant|
|Heart valve repair or replacement||None||Oral examination prior to repair or replacementDental treatment to reduce risk of infection or eliminate infection prior to or following repair or replacement of valve|
To guide its assessment of the evidence about dental care for these five conditions, the committee adapted the evidence pyramid introduced in as shown in . One distinguishing feature of compared to the generic pyramid is that it requires a link between a nondental condition or treatment and either dental services or dental complications. The first tier of the pyramid refers accordingly to the relationship between the medical conditions listed earlier and oral health conditions. The relationship could be manifest either as an increased risk to oral health caused by the medical condition or as an increased risk to systemic health related to poor oral health. The tiers above refer to the effectiveness of dental care in treating oral problems and improving outcomes for the medical condition.
Evidence pyramid for assessing medically necessary dental services. SOURCE: Adapted from IOM/NRC, 1999, p. 89.
Five Decades Later Medicare Might Cover Dental Care
In the large budget bill now in Congress, supporters of the measure see a rare opportunity to advance a popular policy.
Tens of millions of older Americans who cannot afford dental care with severe consequences for their overall health, what they eat and even when they smile may soon get help as Democrats maneuver to add dental benefits to Medicare for the first time in its history.
The proposal, part of the large budget bill moving through Congress, would be among the largest changes to Medicare since its creation in 1965 but would require overcoming resistance from dentists themselves, who are worried that it would pay them too little.
The impact could be enormous for people like Natalie Hayes, 69. Ms. Hayes worked in restaurants, raised a son and managed her health as best she could within her limited means. As she lost her teeth most of them many years ago and her remaining front ones last fall she simply lived with it.
I had a lot of pneumonia, she said, at a recent visit to the Northern Counties Dental Center in Hardwick, Vt. Not a lot of good dental care.
For reference, she showed Colleen Mercier, a dental assistant, an old photograph.
You have a pretty smile, Ms. Mercier said
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Ms. Hayes was also making such judgments. A top set of dentures would give her a smile back. But she had also lost most of her bottom molars. Without a partial set of bottom dentures, she still will be unable to chew many hard foods.
What Do Dentists Want
The ADA is effectively taking a middle road. The group is calling for dental coverage for nearly half of Medicare-eligible seniors whose incomes are 300% or less of the federal poverty level, or roughly $38,000 per year for an individual.
That approach would introduce means-testing to a program that serves more than 61 million older and disabled beneficiaries, “making it look a little bit more like Medicaid,” the public health insurance program for low-income people, Rice said.
The dental group’s positions would align the U.S. with other developed nations, as “most high-income countries do cover dental care for low-income seniors, but most don’t cover it for all seniors,” Rice told CBS MoneyWatch. “It’s an opportunity for the United States to finally look good internationally in terms of its health coverage,” he added of the proposal to offer dental coverage to all Medicare beneficiaries.
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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
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.
Does Medicare Cover Oral Exams
No, Medicare wont cover an oral exam. But, some companies sell Medicare dental plans either alone or bundled with Advantage. Each company is different, and some only carry benefits. Even the most basic plans should cover preventive services like dental exams and x-rays. Sometimes youll have a copay.
Your insurance may pay the full cost of an exam, or you may have to pay part of the bill. Your plan may also require you to choose a primary dentist or use the dentists in the network.
If you need a dental exam because youre having a kidney transplant or heart valve replacement, Part B may cover your exam, but it wont cover any dental work you need.
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Individuals Under Age 21
EPSDT is Medicaid’s comprehensive child health program. The program’s focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state’s Medicaid program.
Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.
Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
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By Bram Sable-SmithOctober 29, 2021
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Dental Care For Patients Undergoing Surgery For Heart Valve Disease
Standard clinical practice is to eliminate as many potential sources of oral infection as possible before a patient undergoes a surgical procedure to repair or replace a defective heart valve. This typically involves an oral examination and x-rays, thorough cleaning, and treatment for any gingival, periodontal, or periapical disease identified. None of these services are covered by Medicare. Standard practice also includes prophylactic use of antibiotics prior to bacteremia-producing dental procedures .
When Should You Get A Standalone Dental Plan
If you’re not signing up for a Medicare Advantage plan that gives you unified coverage across medical and dental, a standalone dental plan is the next best way to get coverage.
You can purchase a plan directly from a private insurance company, and most let you sign up for dental insurance even if you don’t have medical insurance through the company. This plan won’t be connected to your other coverage through the Medicare program, but it can help you get cost-savings benefits so you get the dental services you need.
Benefits of standalone dental plans:
- Choose the level of coverage you want, with plans ranging from basic or preventative coverage to plans that cover more extensive dental treatments.
- Select the insurance company that has your preferred dentists in its network of providers without this choice influencing your medical plan.
Dental plans for seniors include Dental HMOs, which generally have lower monthly costs but only cover care from an in-network dentist. If you’d rather have the flexibility to see any dentist, choose a Dental PPO plan that provides broader coverage but generally costs more each month.
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How Medicare Advantage Dental Coverage Compares To Affordable Care Act Marketplace Coverage
As context for assessing the scope of dental benefits offered to Medicare Advantage enrollees, we reviewed dental coverage available to those who purchase dental coverage through the ACA Marketplaces. Adults purchasing plans through the ACA Marketplace may have dental coverage as part of their medical plan, or may choose to purchase separate stand-alone dental coverage. Among stand-alone dental plans available to adults on HealthCare.gov in 2021 , 100% cover routine preventive dental services , 97% cover basic dental care , and 81% cover major dental care . Unlike the analysis of Medicare Advantage plans, the data on the ACA Marketplace is not enrollment-weighted.
Like Medicare Advantage plans, most plans have little to no cost sharing for preventive services. For adult routine dental coverage, most plans charge no coinsurance , followed by no coinsurance after meeting the dental deductible . The median dental deductible for an individual is $50. For adult basic dental care, the most common cost sharing amount is 50% coinsurance after meeting the dental deductible .
Most plans on the ACA Marketplace have an annual limit the plan will pay toward covered services, typically ranging from $1,000 to $2,000. For stand-alone dental coverage, premiums vary slightly depending on the age of the enrollee. For an adult age 40, the average premium in 2021 is $290 per year, and ranges from $97 per year to $780 per year.
Option : Medicare Advantage Plans With Dental Coverage
Dental coverage varies widely by Medicare Advantage plan. In some cases, you have to pay extra to have dental care included in your plan. There could also be options for basic or premium coverage, letting you choose the dental plan that works for you.
Look for plans that offer low-cost or free preventative services. If you need more expensive treatments, pay attention to the plan’s cost-sharing percentage and the cap on how much the plan will cover each year.
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Among our picks for the best Medicare Advantage plans, Aetna has the cheapest monthly costs. The company reimburses policyholders for in-network dental coverage, and it provides the option for expanded dental benefits at an additional monthly cost. This can be a great way to manage your expenses if you need significant dental services in the upcoming policy year.
If you’re signing up for a new Medicare Advantage plan, you can choose your dental coverage options during the plan selection process. If you’re already enrolled in Medicare Advantage, talk to your provider about what dental coverage options are available to you, and if there is no add-on coverage available, you may be able to enroll in a standalone dental policy.