A question often asked is, “does Medicare offer any dental coverage?” The answer is that it will depends, and there is limited dental coverage under the Original Medicare which doesn’t cover most of the routine dental services. Yet you may find routine dental coverage to be available under a Medicare Advantage plan. These are Medicare-contracted private insurance companies offering various benefits know as Medicare Advantage plans.
The following is an overview covering different situations allowing you to get help on dental costs and how Medicare dental coverages works.
A few exceptions are for example: Certain dental services may be performed in a hospital which Medicare Part A may cover if its part of a necessary covered service. Examples would be reconstructive jaw surgery, preliminary oral exams needed prior to an organ transplant. Procedures related to the care in which Medicare will cover the costs. Oral cancer is another example and if any procedures are outpatient then coverage would be under Medicare Part B.
If you have complications from dental procedures and need inpatient emergency hospital care, then Part A would cover the inpatient hospital treatments. This is even if you do not have dental service coverage.
Remember, even though the Original Medicare will cover a specific emergency dental service, it may not cover any post treatment dental service after the specific issue was treated. While you may have reconstructive jaw surgery under Medicare Part A, your dental care following the surgery may not be covered.
For a more comprehensive dental coverage which would fall under Medicare, you might consider one of the Medicare Advantage plans that are available under Medicare Part C. The plans are offered through various Medicare contracted insurance companies. The plan is required to offer the equivalence of a Original Medicare plan. This doesn’t include hospice care. So, the Medicare Advantage plans cover dental care for the same situations found under the Original Medicare. Many of the Advantage plans will offer additional benefits for your routine dental and vision care, prescriptions drug coverage or wellness programs.
Medicare dental benefits can vary from plan to plan. Some services covered under Medicare Advantage plans can include different routine dental exams and cleanings or X-rays. Things like fillings, crowns, root canals and more. The use of provider networks may be required depending on which Medicare Advantage plan you have. An option to use a non-network dentist may be offered for higher cost sharing levels depending on your specific plan.
Remember additional costs related to dental coverage could include co-payments and deductibles as well as coinsurance. You must continue paying for your Part B premium when enroll in a Medicare Advantage plan in addition to any monthly premiums for the Advantage plan.
PACE the “Program of All-Inclusive Care for the Elderly” is a joint program of Medicare and Medicaid which provides health care services to help keep people living in a community as long as they can; delaying any institutional or nursing home care. If you enroll in PACE, this covers all the services covered with Medicare and Medicaid, so you receive all your Medicare coverage through the PACE organization. This will include doctor services, prescription drug coverage, hospital care and more if it has been deemed necessary by the health care team for your care. Certain benefits like dental services may be include beyond the Medicare program.
If your 55 years old or older and you are enrolled in Medicare, Medicaid or both of these programs you may be eligible. This is also known as a “Dual Eligible.” You must live in a PACE program service area which allows you to live safely in your community environment using the support of the PACE program and be in need of nursing home level care as certified by the state you live in.