One of the most common questions asked for insurance agents specializing in Medicare is, “Does Medicare cover dental services?” It’s one of those questions that need more context or information to answer accurately.
The answer is mostly no — but yes under some very specific scenarios. We will elaborate further so you know why.
Is Routine Dental Care Covered By Medicare?
Medicare doesn’t cover dental services in most instances. Routine cleanings, x-rays, and typical dental procedures are not covered. The only way that Medicare may cover dental is if a disease or accident requires it.
The other time Medicare might step in to help cover a dental procedure is if it’s medically necessary prior to another related procedure. Examples could include:
- Pulling teeth prior to or as part of reconstructive jaw surgery following an accident
- A dental examination before an organ surgery or transplant
- If a disease affects your ability to eat and dental care would alleviate that
The above examples are not very common, so Original Medicare — Part A and B — won’t be covering the vast majority of dental care.
Does Medicare Pay for Oral Surgery?
There are only two scenarios under which Medicare might pay for oral surgery:
- Following an accident
- Needing it related to a diagnosis of jaw cancer
If you need something like gum surgery or teeth extracted, Medicare will not pay for this.
What Dental Services are Covered by Medicare Advantage?
The good news is if you have a Medicare Part C plan — also known as Medicare Advantage — many dental care and procedures will receive some coverage. However, since private companies offer Medicare Advantage plans, you have to make sure that the plan you choose does include the level of dental coverage you anticipate needing.
But if you get a plan with dental benefits, a wealth of services are on offer:
- Root canals
- Tooth extractions
- Cleaning and fillings
But before you purchase a Part C plan, confirm that they are offering the coverage you desire.
Does Medicare Cover an Abscessed Tooth?
This one is a bit nuanced. A regular abscess — which is where the root of a tooth or your gum becomes infected — is not covered if it’s easily treatable. That treatment comes in the form of tooth extraction or root canal.
However, if the infection becomes more severe and spreads, the following could occur:
- Part A would cover any hospitalization you require to cure the ailment.
- Part B covers inpatient care you might need from a doctor visit.
- Part D, if you have this, will cover the cost of antibiotics.
So the short answer is only very severe cases cause Medicare to step in and pick up some of the costs.
How Much Does Medicare Pay for Dental Implants?
Medicare will not pay anything toward dental implants. If you suspect you will need dental implants in the future, your best bet is to look into supplemental insurance to cover you.
Even though that might only cover some of the cost, it could still be cheaper paying a premium and some of the costs than 100% of the bill.
Does Medicare Part B cover dental work?
Yes, but in only extremely specific cases. One example would be reconstructive surgery after a bad accident. But for routine dental work of any kind, the answer will be no.
Does Medicare cover root canals?
If the root canal is needed following or during an emergency room visit pertaining to an accident, it’s possible. But for all other instances, Medicare will not cover a root canal.
Does Medicare cover braces?
Medicare doesn’t cover the implementation of braces. For adults in general, it’s very difficult to find even a supplemental plan or private dental health insurance that will help pay for adults to get braces. However, if you have a child or teenager on your private dental insurance, it would help pay part of the cost for their braces.
Does Medicare cover dentures?
No, Medicare will not cover dentures. If you don’t want to be stuck with 100% of the cost, having a Medicare Advantage or Medigap plan that includes dental insurance will help defray some of those costs.
Does Medicare cover dental crowns?
No, Medicare will not cover the cost of crowns. If this is important to you, you’re better off pursuing a Part C plan or paying for your own dental insurance through a private company.
Does Medicare pay for wisdom teeth removal?
No, Medicare will not cover the cost of wisdom teeth removal. If you have private dental insurance, then you might only be on the hook to pay a portion of the bill.
How to Get Help With Your Dental Coverage Under Medicare
As you can see, Original Medicare covers very little in the way of dental care. If you have a Medigap plan, you’ll need to purchase a separate dental plan to get benefits for dental care.
If you have Medicare Advantage, some plans do include dental benefits, but not all. Whether you want to enroll in a separate stand-alone dental plan or a Medicare Advantage plan that includes dental benefits, we can help!
Give us a call today or fill out our convenient online rate form to get connected with the best rates in your area.