Does Medicare Cover Dental Work?

Overview of Medicare Coverage for Dental Work

Medicare is a federal health insurance program for people who are 65 years old or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD). But does Medicare cover dental work? The answer is both yes and no – depending on the type of dental service you need.

What is Covered?

According to the Centers for Medicare & Medicaid Services (CMS), “Original Medicare generally doesn’t pay for most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.” This means that Medicare Part A and Medicare Part B do not typically cover routine dental services such as exams, cleanings, fillings, root canals, crowns, bridges, dentures, or braces.

What is Not Covered?

However, there are some exceptions. Medicare may cover certain dental services that are medically necessary, such as those related to a hospital stay, a kidney transplant, or cancer treatment. For example, if you need to have a tooth extracted before receiving radiation therapy for head or neck cancer, Medicare may cover it. In addition, Medicare may cover certain dental services that are performed in a hospital setting.

How to Find Out If You Are Eligible

If you think you may be eligible for Medicare coverage of dental services, contact your local Social Security office. They can help you determine if you qualify for Medicare coverage and explain what services and supplies are covered.

Types of Dental Services Covered by Medicare

Medicare may cover certain types of dental services, including preventive, diagnostic, and restorative care. Here’s a look at each type:

Preventive Care

Preventive care includes services such as dental exams, x-rays, and cleanings. According to CMS, “Medicare Part A may cover preventive dental services when they’re part of an inpatient hospital stay. These services must be medically necessary and ordered by your doctor.”

Diagnostic Care

Diagnostic care involves services such as x-rays and lab tests. Medicare Part B may cover these services if they’re medically necessary and ordered by your doctor.

Restorative Care

Restorative care includes services such as fillings, crowns, and bridges. Medicare Part B may cover these services if they’re medically necessary and ordered by your doctor.

How to Find a Dentist Who Accepts Medicare

Once you’ve determined that you’re eligible for Medicare coverage, you’ll need to find a dentist who accepts Medicare. Here are a few tips:

Searching for a Dentist

You can search for a dentist in your area who accepts Medicare by using the Medicare Plan Finder tool on the CMS website. Simply enter your zip code and select “dentist” from the list of provider types.

Verifying Coverage with the Dentist

Once you’ve found a dentist in your area who accepts Medicare, call the office to verify that they accept your specific plan. You should also ask about any additional fees or out-of-pocket costs you may be responsible for beyond what Medicare covers.

Costs of Dental Care Covered by Medicare

The cost of dental services covered by Medicare will vary depending on your plan. Generally, Medicare Part B covers up to 80 percent of the cost of medically necessary dental services. You may be responsible for the remaining 20 percent in the form of deductibles, copayments, or coinsurance. Here’s a closer look at each:

Deductibles

A deductible is the amount you must pay out-of-pocket before your insurance kicks in. The amount of your deductible depends on your plan.

Copayments

A copayment is a fixed fee you pay for a covered service. Your copayment will depend on the type of service you receive.

Coinsurance

Coinsurance is the percentage of the total cost of a service that you must pay. For example, if your coinsurance rate is 20%, you would pay 20% of the total cost of a covered service.

Alternatives to Medicare Coverage for Dental Care

If you’re not eligible for Medicare coverage of dental services or you need more extensive dental care than Medicare will cover, there are other options available. Here are a few:

Medicaid

Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. It may cover a variety of dental services, including preventive, diagnostic, and restorative care. To find out if you’re eligible for Medicaid, contact your state’s Department of Health and Human Services.

Private Insurance

If you’re not eligible for Medicaid, you may be able to purchase private insurance to cover dental services. Private insurance plans vary in cost and coverage, so be sure to compare plans carefully before enrolling in one.

Discount Dental Plans

Discount dental plans are another option that may provide discounted rates on dental services. With a discount dental plan, you pay an annual fee and receive discounts on dental services from participating providers. To find out if there’s a discount dental plan in your area, contact your local dental society.

Other Options

There are a number of other options available to cover the cost of dental care. For example, many employers offer dental coverage as part of their employee benefits package. Additionally, some community health centers and dental schools offer reduced-cost dental care. Finally, some dentists offer payment plans for patients who cannot afford to pay for services in full.

Conclusion

Medicare does not typically cover routine dental services such as exams, cleanings, fillings, root canals, crowns, bridges, dentures, or braces. However, Medicare may cover certain dental services that are medically necessary, such as those related to a hospital stay, a kidney transplant, or cancer treatment. There are also a number of other options available for covering the cost of dental care, such as Medicaid, private insurance, discount dental plans, and payment plans.