Table of Contents

• The Basics of Medicare & Your Teeth
• When Original Medicare Does Pay
• How Medicare Advantage Changes the Rules
• Other Ways to Save on Dental Costs
• FAQ

Does Medicare Cover Dental Care?

Did you know that most people who rely on Original Medicare have to pay for their dental cleanings and fillings entirely out of their own pockets? While your health insurance covers almost every part of your body, your mouth is often treated as a separate category - this can lead to unexpected bills when you visit the dentist for a checkup or a new set of dentures.

You might find it strange that Medicare Part A besides Part B stay away from routine tooth care - these programs are designed for hospital stays and medical visits but they generally exclude the services you receive at a dentist's office. If you need a tooth pulled or an X-ray to check for cavities, Original Medicare is usually not going to help you with the cost.

The Basics of Medicare & Your Teeth

Original Medicare consists of Part A (hospital insurance) & Part B (medical insurance). Neither of these parts is built to handle routine dental health, which means you are responsible for the full price of common services. Because there are no standalone dental plans offered directly by the government, you cannot simply add a dental "rider" to your existing Medicare coverage.

Many people assume that a Medicare Supplement (Medigap) policy will fill this gap. Medigap only helps pay for the costs that Original Medicare already covers, like deductibles and co pays. If the primary insurance does not cover the service at all, the supplement will not pay for it either. You should prepare to manage these costs separately if you only have the types of plans.

When Original Medicare Does Pay

There are rare moments when Medicare is willing to step in - these situations are usually limited to medical emergencies or procedures where your dental health is vital for another surgery to succeed. As an example, if you are in a serious accident and need jaw surgery in a hospital, Part A may cover those specific dental repairs.

The rules are also changing to be slightly more helpful for individuals with serious chronic conditions. Medicare may cover dental exams and treatments in the following cases

• A dental exam is required before you can receive a kidney transplant.
• You need diagnostic dental services because you are a patient receiving dialysis.
• The dental work is a necessary part of a procedure to treat oral cancer.

How Medicare Advantage Changes the Rules

Medicare Advantage, which is also known as Part C, is different because private companies run these plans. To attract members, many of these companies include extra benefits that the government run program does not have - this is where you are most likely to find help with your dental bills. Many Advantage plans are comprehensive and include routine maintenance for your teeth.

When you look at a Medicare Advantage plan, you should check the fine print carefully. Not every plan is the same and some offer more generous limits than others. Common services covered by the private plans include

• Annual or semi annual cleanings and exams.
• Standard X-rays to monitor your bone and tooth health.
• Simple procedures like fillings or tooth extractions.

Other Ways to Save on Dental Costs

If you prefer to stay with Original Medicare but still want protection for your teeth, you have a few choices. You can purchase a private, standalone dental insurance policy from a commercial provider - these plans require a monthly payment but they can lower the cost of expensive work like crowns, bridges or root canals later on.

Another option is a dental discount plan - This is not insurance but rather a membership that gives you access to lower rates at participating dentists. You pay the dentist directly but the price is much lower than what an uninsured person would pay. Some people also look for dental schools in their area, where students perform work at a deep discount under the watchful eyes of experienced instructors.

FAQ

Does Medicare pay for dentures?

No, Original Medicare does not pay for dentures - You would need to have a Medicare Advantage plan that specifically includes coverage for prosthodontics or buy a separate private dental policy to get help with the cost of dentures.

Can I buy a dental plan through Medicare?

Medicare does not sell standalone dental plans - You must either join a Medicare Advantage plan that includes dental benefits or find a private insurance company that sells dental insurance to individuals.

What if I need a tooth pulled because of an accident?

If the extraction is part of a larger emergency treatment for a traumatic injury and you are hospitalized, Medicare Part A may cover the service. If you just need a tooth pulled because of decay, you are responsible for the bill unless you have extra private coverage.