Dental hygiene becomes more and more important as we age. Seniors can experience gum disease, tooth decay, and other dental conditions.
Unfortunately, Medicare doesn’t cover as much dental work as most seniors expect it to. In fact, Medicare barely covers any dental work at all. Medicare only covers medical services and items that are deemed medically necessary. Medicare doesn’t consider dental work medically necessary.
With that said, there are a few situations where Medicare may consider a certain dental procedure or service to be medically necessary and therefore, may cover it. Let’s look at some of the dental services Medicare may cover in specific situations.
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Routine Dental Work
Routine dental work such as teeth cleanings, exam, and fillings aren’t covered by Medicare. However, there is one exception where Medicare may cover a routine dental exam. That scenario would be if you have major surgery, such as a heart surgery, scheduled, and your doctor orders you to get a dental exam prior to the surgery, Medicare may cover it.
In the case that Medicare does cover your dental exam, Medicare Part B would be in charge of coverage. Part B would cover 80 percent of the bill after you have met your Part B deductible. You will be responsible for the other 20 percent as well.
Oral surgery such as removal of wisdom teeth isn’t covered by Medicare either. However, if you have a medical condition such as oral cancer, then Medicare may cover some or all of the surgery if it’s needed to help treat the condition.
If you are admitted to a hospital as an inpatient for your oral surgery, Medicare Part A will pay for your hospital services such as your room and your meals, whether your surgery is covered or not. Medicare Part B will likely be the part to provide coverage for the surgery if Medicare accepts the claim.
Dentures are considered to be a cosmetic dental item and therefore, isn’t covered by Medicare ever. Although Original Medicare doesn’t cover dentures, most Medicare Advantage plans include a supplemental dental benefit. If you are enrolled in a Medicare Advantage (Part C) plan that includes a dental benefit, you will likely be able to get your dentures covered as well as other dental services.
If you have a Medigap plan instead of a Medicare Advantage plan, there are stand-alone dental plans you can enroll in to access dental coverage. For instance, Manhattan Life has a stand-alone dental, vision, and hearing (DVH) plan. This specific plan doesn’t have any networks, which means you can use this insurance at any dentist’s office.
Other Alternatives for Dental Coverage
Seniors have a few options when it comes to obtaining dental coverage. For instance, there are the stand-alone DVH plans we mentioned, dental discount plans, prepaid dental plans, and even Medicare Advantage plans.
Medicare Advantage plans, also known as Part C of Medicare, is a type of plan you can enroll in to take over your Medicare coverage. A Medicare Advantage plan will pay instead of Original Medicare. Although you still must be enrolled in Part A and Part B to get a Medicare Advantage plan, the plan will be how you obtain health coverage. Also, Medicare Advantage plans usually have a monthly premium that you pay in addition to your Original Medicare premiums, although there are many $0 premium plans available.
Most Medicare Advantage plans include supplemental benefits. Supplemental benefits are benefits that Original Medicare doesn’t cover, such as dental. Medicare Advantage plans are also known to cover vision, hearing, and drug benefits.
If having dental coverage is important to you and you want an all-inclusive plan, perhaps you should consider a Medicare Advantage plan.