When it comes to oral health care and dental coverage, Medicare is generally lacking. In addition to the normal requirements for Medicare plans (age 65 or older and/or those with disabilities), the federal government limits Medicare Part A and Part B dental coverage to services deemed “medically necessary.”
As you might expect, “medically necessary” means any treatment or service ordered by a physician. Here it also means that only certain dental procedures that act as prerequisites for more involved medical treatments will be approved. For example, if your doctor recommends a dental exam prior to heart valve replacement surgery, Medicare would cover the dental exam. Another example is a patient with oral cancer who may need treatment before their normal radiation therapy. In this case, Medicare would again provide dental coverage. Sometimes Medicare may also cover jaw disease procedures. It may even cover surgery to repair your jaw after a severe accident.
Medicare will occasionally pay for hospitalization costs incurred as the result of dentistry problems. If, for example, you have a tooth extracted and then develop an infection as a result of the procedure, Medicare will likely pay for any hospital or dental treatment costs.
Alternative options for coverage
Original Medicare (Parts A and B) will not cover normal oral hygiene procedure costs. These procedures include root canals, dentures, fillings, teeth cleaning, and tooth extractions. Medicare Part C, sometimes referred to as Medicare Advantage, may cover these types of oral procedures. Advantage plans are offered by traditional health insurance providers (Aetna, United, etc.) operating under federal guidelines. These services are typically offered at low cost to Medicare-eligible citizens who join what is called a fee-for-service plan. However, unlike Medicare Parts A and B, your local hospital and physicians are not required to accept Medicare Plan C terms. They may choose not to provide you with the dental services you need except in cases of emergency. Check with your doctor and your local insurance provider to determine if a Medicare Advantage plan will meet your needs.
You may also opt to enroll in Medigap coverage. This supplemental health insurance provided by third-party insurance carriers is designed to fill the gaps in Medicare’s existing coverage. Medigap plans vary in terms of cost and services covered, so it is important to compare plans and make sure that you’ll receive the proper coverage before you pay into a given plan.
If neither Medicare Advantage plans nor Medigap coverage fit your particular needs, you should consider contacting the Dental Lifeline Network. The DLN is a non-profit organization founded in 1974 that provides access to dental care and education for people who cannot otherwise afford it. The network focuses particular attention on the elderly and people with permanent disabilities. You can apply for assistance and search for Dental Lifeline Network facilities by state at the company’s website.