Dental Coverage & MedicarePosted by Medicare Made Clear
In general, Medicare doesn’t pay for dental care.* It doesn’t cover routine check-ups, cleanings, fillings or any other of the usual dental procedures. It doesn’t pay for dentures, dental plates or other dental devices. Medicare only covers getting teeth pulled in very limited circumstances. For the most part, the bottom line is this: If you have Original Medicare (Medicare Parts A and B, you’re responsible for the cost of all your routine dental care.
Can you skimp on, or go without routine dental care? That’s not a good idea. Researchers are finding more and more connections between oral health and overall health, as described in 2013 article from the Mayo Clinic. Conditions that may be worsened by poor dental health—or may worsen dental health themselves—include heart disease, diabetes, osteoporosis and Alzheimer’s disease.
So, what are your options for dental coverage when you have Medicare? Here are a few possibilities to investigate.
1. A Medicare Advantage plan with dental coverage.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They’re required to cover everything that’s covered by Original Medicare. Many Medicare Advantage plans offer additional benefits, including coverage for prescription drugs, vision, hearing, fitness and dental – all in one plan.
Each Medicare Advantage plan has a service area. This is a geographic area where the plan is available and offers coverage. A service area is usually a county, state or region. You must live in a plan’s service area in order to enroll in that plan.
You can research Medicare Advantage plans in your area using the Plan Finder at Medicare.gov. You may also want to ask your dentist what plans he or she participates in. Some Medicare Advantage plans require you to use a dental health provider who’s part of their contracted network.
2. Your state Medicaid plan.
In some states, Medicaid covers some dental services. Of course, you need to first qualify for Medicaid in order to receive these services. That usually means having a low income and few assets. You can contact your state Medicaid office to learn more.
3. Local low- or lower-cost sources of dental care.
Here are some options that may be able to help you with the costs of dental care:
- Call your local hospitals to ask whether they offer dental clinics. They can also tell you if you can become a patient, which services are available and what fees there are.
- Community health centers across the U.S. provide free or reduced-cost services, such as dental care. They receive funding from the Bureau of Primary Health Care, a service of the Health Resources and Services Administration (1-888-ASK-HRSA).
- Some dental and dental hygiene schools have clinics that allow students to gain experience while providing care at a reduced cost. Experienced, licensed professionals supervise the students.
Contact your local United Way for more information on no-cost or reduced-cost dental care available where you live.
4. A private dental insurance plan.
Various private companies offer dental insurance to individuals. You can search for plans available in your area online or in the phone book. Your state’s health department may also be able to help.
*There are exceptions to this statement. Medicare pays for certain dental procedures, if they are related to a covered medical condition. For example, it covers jaw reconstruction after an injury, or tooth extractions before cancer radiation therapy. Medicare also covers oral examinations (but not treatment) before a kidney transplant or a heart valve replacement, under certain circumstances.
These select covered dental procedures must be necessary to treat a non-dental condition. They must be performed at the same time as treatment for the covered condition and by the same doctor or dentist.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
Health Center Finder: An online tool from the Health Resources and Services Administration to search for community health centers.
Medicare & You: The official Medicare handbook, updated for 2014.
Medicare Interactive: A website of resources created and maintained by the Medicare Rights Center.