Medigap Plans And Oral Surgery
Medigap plans are insurance plans that work alongside your Original Medicare coverage to help fill in the “gaps” of Medicare deductibles, coinsurance, copays and more.
Medigap plans don’t typically cover health services such as oral surgery. If your oral surgery is covered by Medicare, however, a Medigap plan could help you save potentially large amounts of money on the out-of-pocket Medicare costs for your surgery.
As mentioned above, you’re typically responsible for 20% of the Medicare-approved amount if your oral surgery is covered by Medicare. This 20% copay could add up quickly. A Medigap plan that covers your Medicare Part B coinsurance would pay for those costs.
Which Dental Services Do Medicare Advantage Plans Cover
Private insurers provide Medicare Advantage plans. That means your Medicare costs may vary depending on the plan you chooseand so could your dental coverage. Some plans don’t include dental at all or require you to pay an additional premium to add this coverage. Medicare Advantage plans that do include dental services typically offer either preventative or comprehensive dental.
American Hospital Association Disclaimer
The American Hospital Association has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
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Why Should I Continue Undergoing Bi
Preventive care is crucial to your oral health and your overall well-being. It is especially important for our oldest patients, who are at higher risk for developing gum disease and oral cancer. Often, conditions such as a dental infection or minor cavities do not present with any signs or symptoms. However, a dental professional can identify these issues early on and perform appropriate treatment before you require more costly and extensive restorative procedures. Timely treatment can not only save you time and money but protect your dental function, and in turn, your quality of life.
What Are Medicare Advantage Plans
Advantage plans are supplemental insurance plans that provide a spectrum of benefits that arent included in the traditional Medicare plan. Advantage plans have a network of providers that provide lower out-of-pocket limits, lower deductibles, and lower rates overall for covered procedures. In a traditional Medicare plan, the provider must be reimbursed by the government for services rendered to Medicare patients, which can take months. Under the Medicare Advantage plans, the insurer pays the healthcare provider directly, which means that the provider is paid in a more timely manner. Advantage plans often include hearing, vision, and prescription drug coverages, and they have a separate identification card. Aetna, Humana, and UHC are the most popular and well-known providers of Advantage plans, and they endeavor to keep the premiums affordable so that seniors can obtain the healthcare services that they need. The scope of dental coverage they provide is usually limited to cleanings, basic checkups, and standard x-rays.
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Working With You To Maximize Your Coverage
At Smiles for Life Dental Care, we believe that cost should not prohibit you from receiving the dental care you need. If you have Medicare, we will work with you to help maximize your coverage. To schedule your consultation with Dr. McIntyre or Dr. Whiting, contact our office online. You can also call our office at 208-5911 to speak with a member of our staff about any questions you may have about Medicare and dental care.
What If I Cant Afford Dental Insurance
Dont let financial stress keep you from receiving the dental care you need. If you have limited income, you may be able to seek care from other sources, including:
- Medicaid: Many Medicaid programs offer dental care as part of their coverage. Medicaid coverage is state-based, so where you live determines coverage.
- Dental schools: Many dental schools allow volunteers to receive no-cost dental care in return for being treated by a student.
- Dental and health clinics: Many areas offer reduced- or no-cost community health benefits, including dental care.
- Clinical trials: Some organizations like The National Institutes of Dental and Craniofacial Research occasionally need volunteers to participate in studies that examine specific oral and dental conditions. If you qualify, you may receive no- or reduced-cost dental care.
If you or a loved one are on Medicare and need coverage for oral surgery, give GoHealth a call. Well review your plan and make sure you have the benefits youre looking for. If not, well shop for other plans in your area that do. We want your health plan to handle all of your needs, from everyday health to those issues that pop up including oral surgery.
What Is Oral Surgery
Risk for conditions such as gum disease and oral cancer increase as you get older. Typically, if your regular dentist finds something that requires oral surgery, they will refer you to an oral surgeon or specialist. This surgeon can perform tooth extraction, jaw surgery, dental implants, or biopsies if necessary.
Oral surgery can include dental procedures for issues affecting your teeth, gums, jaw and even facial bones. There are three most common circumstances you may need to see an oral surgeon:
- Tooth Extraction: While your regular dentist can usually perform tooth extractions , you may need to be referred to an oral surgeon for complex extractions or wisdom tooth removal.
- Corrective Surgery: If you have been in an accident and have fractures in your face or jaw, you may require wiring or dental splints to help you heal properly. An oral surgeon can help with this.
- Restorative Surgery: Removing tumors from the mouth or face, and repairing or reconstructing the area, can be done by an oral surgeon.
Oral Health Problems Related To Treatment For Leukemia And Lymphoma
In addition to oral symptoms arising from the disease itself, chemotherapeutic treatment frequently induces oral health problems, in particular, mucositis and stomatitis . These problems arise both from immunosuppression, which results from damage to the blood-forming cells in the bone marrow, and from direct drug toxicity to the oral mucosal cells lining the mouth.
Severe mucositis and stomatitis can involve extensive ulceration, intense pain, and disfiguring destruction of tissue. These problems may interfere sufficiently with chewing or swallowing to cause malnutrition or dehydration. In addition, while patients are severely immunosuppressed from chemotherapy, they may experience acute exacerbations of asymptomatic periodontal disease . In general, the more extensive the chemotherapy, the more serious and widespread these adverse oral conditions are likely to be. For some patients, adjustment of the chemotherapy regimen may reduce the severity of mucositis or stomatitis.
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Does Medicare Cover Wisdom Teeth Removal
In most cases, Medicare does not cover wisdom teethremoval .
Wisdom teeth are the last teeth to appear in your mouth, found the farthest back. Sometimes, wisdom teeth become impacted, or stuck, and they grow at an odd angle, causing complications. Other times, wisdom teeth dont form or grow in at all. When wisdom teeth cause problems, such as pain, they may need to be removed. They can also cause damage to other teeth, including moving them around.
Usually, wisdom teeth come in when youre between the ages of 17-25. After that, if you havent had issues or pain, you likely never will.
How And When Do I Enroll In Medicare
Enrollment begins three months prior to your 65th birthday and extends for an additional seven months. Those currently receiving Social Security benefits will automatically be enrolled in Medicare at age 65. It is important to note that Original Medicare has two parts: Part A, for hospital coverage, and Part B, for medical coverage.
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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 .
Understanding Your Medicare Dental Coverage
If you are suffering from a dental issue that is affecting your oral and physical health, your dental treatment may be covered by your Medicare insurance plan. Medicare provides coverage for procedures that are deemed medically necessary, ranging from minor treatment to major surgery. Our team at Smiles for Life Dental Care can conduct a thorough examination to determine if your issue requires necessary intervention and help you navigate your coverage. To ensure our Staunton and Bridgewater, VA, patients understand their dental coverage under Medicare, we have compiled commonly asked questions and answers.
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Research Finds Cost A Barrier To Dental Care
Unlike the ADA, the National Dental Association is pushing for a universal Medicare dental benefit. The group, which “promotes oral health equity among people of color,” was formed in 1913, in part, because the ADA did not eliminate discriminatory membership rules for its affiliates until 1965. Dr. Nathan Fletcher, chairman of NDA’s board of trustees, says he was unsurprised to find his organization at odds with the ADA over Medicare coverage.
“The face and demographic of the ADA is a white male, 65 years old. Understand that those who make decisions for the ADA are usually the ones who have been in practice for 25 to 30 years, doing well, ready to retire,” Fletcher says. “It looks nothing like the we’re talking about.”
Research from the ADA’s Health Policy Institute found cost as a barrier to dental care “regardless of age, income level, or type of insurance,” but low-income older adults were more likely to report it as a barrier.
Your Costs For Oral Surgery Under Medicare And Medicare Advantage
Your costs for oral surgery vary depending on the type of procedure and the type of Medicare coverage you have.
Even though services covered under Original Medicare do not include oral surgery, tooth extractions or other dental care in most cases, these services may be covered under a Medicare Advantage plan.
Medicare Part D prescription drug plans can also help with the cost of prescription drugs you will need following oral surgery. Medicare Advantage plans usually come with a Part D plan.
Your Costs Under Different Parts of Medicare
Medicare Advantage and Medicare Part D prescription drug plans are sold by private insurers. You should check with your plans administrator to see exactly what your plan covers.
What Benefits Will I Receive From My Health Fund
Below is a table which indicates whether you can expect to receive a benefit towards your oral surgery procedure, based on the type of cover you have.
This information applies if you have an appropriate level of Hospital cover and/or General Treatment cover that includes cover for wisdom tooth extraction, and if you have completed the appropriate waiting periods .
Medicare Advantage Dental Benefits In Jupiter
The senior demographic is defined as anyone who is 65 years or older, and they comprise almost 20% of the U.S. population. That number will increase steadily because every day, more than 10,000 Americans reach that age. Seniors are also the least likely to have affordable dental care because of a lack of insurance. When they were employed, most of them had insurance coverage through their employers. Upon retirement, however, many were left without the means to provide adequate insurance for themselves and their families. Approximately 65% of seniors have no dental insurance and the result is that they forego needed dental treatment.
Even without insurance, seniors spent $28 billion in 2016 to pay for needed dental care, resulting in the highest expenditures for dentistry of any demographic. A study conducted by the Kaiser Family Foundation found that half of all Medicare recipients hadnt seen a dentist in the preceding year, and almost 20% of those who did, spent more than $1,000 on out-of-pocket expenses for routine dental work. The reason for these somewhat alarming statistics may be the cost of dental procedures.
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Coverage For Medically Necessary Oral Health Care Is Unduly Restricted By Medicares Dental Policy
May 11, 2016
Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history and, in some instances, even CMS policy. For this purpose, medically necessary oral health care refers to treatment deemed necessary by a physician when a patients medical condition or treatment is or will likely be complicated by an untreated oral health problem.
The Medicare Dental Exclusion is Limited and Should be Interpreted Narrowly
The statutory dental exclusion bars Medicare payment for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth . The exclusion is limited to routine dental work that is primarily for the care of the teeth. Nothing in the statutory language restricts coverage of oral health care for the medically necessary treatment or diagnosis of an illness or injury. As such, the dental exclusion does not apply to procedures that are deemed medically essential to diagnose, treat, or manage serious health problems that extend beyond the teeth and supporting structures.
Payments would not be made for routine physical examinations or for eyeglasses, hearing aids, or the fitting expenses or other costs incurred in connection with their purchase. The committee bill provides a specific exclusion of routine dental care to make clear that the services of dental surgeons covered under the bill are
Defining Medically Necessary Dental Services
The 1997 Balanced Budget Act, which provided for this study, included no definition of medically necessary dental services. One definition of such services is found in a bill submitted earlier in 1997 . It called for coverage of dental services that are medically necessary as a direct result of, or will have a direct impact on, an underlying medical condition if the coverage of such services is cost-effective . It also included explicit provisions for Medicare to cover dental care related to several specific illnesses. The bill’s languageminus the wording about cost-effectivenessis similar to that used three years earlier in a bill that included medically necessary oral health care in a proposed set of basic benefits to be covered as part of broad health care reform . This earlier proposal also included oral care intended to control pain and infection and to restore function. The committee understands these definitions of medically necessary servicesparticularly the one proposed in 1997to be narrowly constructed to continue the general exclusion of Medicare coverage for dental care but to broaden the scope of the exceptions to include dental care needed to prevent or effectively manage systemic conditions including the oral complications of specific illnesses or their medical treatment.
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Does Medicare Pay For Oral Surgery
If oral surgery is deemed medically necessary and is performed by a Medicare-participating doctor or surgeon, it may be covered by Medicare.
Examples of covered oral surgery may include:
- Part of a treatment plan for certain medical conditions, such as cancer or heart disease.
- Part of a covered procedure, like reconstruction of your jaw after an injury.
- Oral exams prior to a heart valve replacement or kidney transplant.
- Tooth extraction prior to radiation treatments.
- Jaw reconstruction after removal of a tumor.
- Surgery to treat fractures of the face or jaw, including wiring or dental splints.
In these cases, oral surgery would be covered either by Medicare Part A or Part B.
- Part A Coverage: If you are an inpatient in a hospital and need to have an emergency or dental procedure, and the procedure is completed by a Medicare-approved dentist on the hospital’s staff, the procedure will likely be covered. This includes if youre treated in:
- Acute care hospital
- Inpatient care as part of a qualifying research study
- Mental health care
Medicare will cover some costs if you require a dental-related hospitalization, such as room and board, anesthesia and x-rays. However, it still will not cover dental services excluded from Original Medicare coverage, such as dentures.
Medicare Part D drug coverage would also kick in and cover any approved medications that are prescribed to you before or after a dental procedure.
Cost Under Medicare Advantage
Some Medicare Advantage plans, also called Medicare Part C, may cover oral surgery for dental health. Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare and include:
- Part A and Part B coverage
- Supplemental benefits such as dental, health and vision
Not all Medicare Advantage plans offer dental benefits, so be sure to check the terms of your policy. The types of dental benefits also vary. Some plans may cover only preventive dental services, such as cleanings and X-rays.
About 2 out of 5 Medicare Advantage plans offer comprehensive dental for restorative procedures, according to the Kaiser Family Foundation. If your Medicare Advantage plan covers oral surgery, your out-of-pocket cost will vary depending on your deductibles and copays.
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Would Most Dentists Take Medicare Patients
Of course, covering only low-income seniors presents its own questions, the biggest being: Will dentists even accept Medicare if they don’t have to? Low-income patients often seek their dental care at safety-net clinics that schedule out months in advance. Some dentists worry that a Medicare benefit limited to low-income older adults would be easier to shun, pushing even more newly insured Americans into an already burdened dental safety net.