Although there have been discussions in Congress about expanding Medicare coverage to dental and other areas, for the most part dental benefits are not currently covered.
However, there are some exceptions and other ways to get affordable dental coverage.
Let's start with what's not covered. Original Medicare does not cover most preventive and healthy dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions (including wisdom teeth), root canals, dentures, or dental plates.
However, Medicare Part A will pay for some dental services you get in the hospital. If you have an inpatient dental emergency or a complicated dental procedure, you may be covered. Covered services may also be available to protect your general health or if you need dental care for another Medicare-covered health service to be successful. For instance, Medicare may cover:
Medicare may cover these initial dental services but will not pay for any follow-up dental care after the underlying health condition has been treated.
In these cases, Medicare will cover hospitalization costs such as room and board, anesthesia, and x-rays. However, Medicare will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.
Depending on the policy you select, insurance companies may offer extra dental benefits when you buy a Part C plan with a separate monthly premium. Not all Part C plans offer enhanced dental insurance.
One of the biggest questions people have is whether a Medicare Advantage plan covers dentures. Again, the short answer is "it depends."
There are two types of dentures: a complete set or a partial set. Implant dentures are surgically and permanently implanted in the jaw.
Part C dental plans may cover both types. Before you buy coverage, talk to your dentist to see which type of dentures are best for you.
It may be hard to find a plan covering adult orthodontic work (braces). If you find one, expect to pay a percentage of the cost as a copayment or deductible. If you find a plan that covers orthodontics, chances are it will also cover invisible aligners. Most companies treat invisible aligners as a form of braces.
Another thing to consider is that a plan may have a coverage limit for enrollees. In many cases, cleanings and x-rays may be covered only once or twice a year. Overall, the maximum annual coverage is typically between $1,000 to $2,000.
Most Medicare Advantage plans will require you to visit in-network providers. You will also need to select a primary provider in most cases.
If you need dental care, you may want to buy a stand-alone plan instead of a Part C plan. Medicaid may also be an option if your income meets the criteria.
There's one other important thing to note. Medicare supplement insurance (Medigap) plans cover the same procedures as Medicare. They are not the same as a Part C plan. Since Medicare doesn't cover routine dental services, supplement plans don't cover them either.
DISCLAIMER: Medi-Solutions Insurance Agency, LLC is not affiliated or endorsed with the Social Security Administration or the Federal Medicare Program. Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment, or legal advice. Please consult legal or tax professionals for specific information regarding your individual situation.
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