Medicare’s dental coverage is very sparse. The federal government’s over-65 health care program is lacking when it comes to oral treatments. Medicare Part A and Part B do occasionally cover medically necessary treatments such as dental checkups before heart surgery or oral treatments required for radiation therapy. Sometimes, tooth extraction procedures also fall under this “medically necessary” umbrella.
However, even if Medicare elects to pay for a tooth extraction in preparation for another procedure, chances are high that you will be responsible for the full cost of implants or dentures following the extraction. Medicare will also decline to pay for any follow-up treatments that may be required after a tooth extraction procedure.
Special procedures in preparation for major surgery are where Medicare stops in terms of oral care. If you’re looking to the government to assist you in paying for general tooth extractions and other common oral procedures, unfortunately you’ll need to look elsewhere. Medicare will almost certainly decline to cover tooth extraction costs unless specific conditions are met. Those conditions include, but are not limited to, hospital stays that result from infections sustained during tooth extraction procedures. If you’re unlucky enough to develop this type of oral infection after a tooth extraction procedure, then Medicare will probably pay for the cost of the treatment as long as you are properly enrolled in Part A or Part B.
Medicare Part B occasionally covers treatment for problems with the jaw and the bones of the mouth, which are sometimes related to tooth extraction. The key is that any procedures performed must be deemed medical instead of dental. What is the distinction between these two? The difference involves whether or not the performing specialist is a licensed medical doctor. Procedures performed by a specialist who is not an M.D. are considered dental. Medicare has the final say as to whether a particular treatment is a dental procedure or a medical procedure.
Medicare Advantage Plans may help
Medicare Advantage plans (sometimes referred to as Medicare Part C) may solve your tooth extraction payment problems. However, there are a wide variety of plans and an equally wide variety of coverage types, costs, and provider companies. To find out what Medicare Advantage packages include basic dentistry services, you should speak with an insurance specialist.
Another option is Medicaid. Some Medicaid plans do include general dentistry and tooth extraction coverage. That said, Medicaid is limited to low-income Americans and its benefits vary widely from state to state. Other private insurance initiatives like Medigap are also an option.
If Medigap, Medicare Advantage, or Medicaid don’t meet your needs for tooth extraction assistance, you may also want to consider a Health Savings Account. These accounts require you to contribute tax-free funds in preparation for future medical services. HSAs are usually owned by you instead of a third-party company. The money in an HSA rolls over from year to year if it is not spent. Contact your employer to see if they offer HSA benefits. If not, conduct an internet search for local HSA providers in your area.