According to the American Dental Association, oral health problems are a major source of emergency room visits for senior citizens. In fact, the Centers for Disease Control and Prevention (CDC) states that about 68% of seniors 65 years and older have gum disease. Since Medicare is health insurance for American seniors 65 years and older, you would assume Medicare covers dental treatment. You can visit https://boomerbenefits.com/dental-insurance/ to learn more about senior dental insurance but keep reading to see how Medicare covers dental treatment.
What does Medicare cover?
First, let’s start with what Medicare Part A and Part B cover.
Medicare Part A covers the care you receive as an inpatient at the hospital, such as your hospital room, meals, lab services, and medications. Part A also covers skilled nursing, hospice, and home health care.
Part B covers your outpatient care such as surgeries, doctor’s visits, physical therapy, and more.
What’s important to note is that Original Medicare covers services that are considered to be medically necessary. But what does medically necessary mean?
What does medically necessary mean?
Medicare considers healthcare services medically necessary whenever a service is performed to diagnose or treat an injury, illness, or disease. So, does Medicare consider dental treatment to be medically necessary? You will be surprised.
Does Medicare cover dental treatment?
Medicare does not cover routine dental treatment. Therefore, Medicare doesn’t cover dental cleanings, fillings, root canals, annual x-rays, crowns, or tooth extractions. If you were to visit your dentist and have them conduct any of these services, you would pay the total cost if you do not have another form of dental insurance.
But, if you need dental work related to another health condition, then it will likely be considered medically necessary, and Medicare will likely cover it. Here’s an example –
Let’s say you experience an accident that results in a broken jaw, and you now need jaw surgery. Medicare will likely cover your surgery in this case. If you receive jaw surgery as an inpatient at the hospital and you’re an inpatient for 3+ days, then Medicare Part A will cover your surgery. You will be subject to the Part A deductible ($1,556 in 2022). If you are in the hospital for more than 60 days, you will begin to pay a daily copayment if you do not have secondary insurance.
But, if your jaw surgery is performed in an outpatient facility, you will pay the Part B deductible of $233 (2022). After you meet the deductible, Part B will cover 80% of the Medicare-approved charges, and you will pay a 20% coinsurance (if you don’t have secondary insurance).
So, Medicare may cover your dental treatment when medically necessary. But, Medicare does not cover routine dental services. Due to this, many beneficiaries purchase a Medicare Advantage plan.
Medicare Advantage plans and dental treatment
Medicare Advantage plans, also known as Medicare Part C, are an alternative to Original Medicare. Private insurance carriers sell Advantage plans, and when you enroll in one of these plans, you will receive your Part A and Part B benefits through your insurance carrier. The carrier will create a network of providers for you and set your cost-sharing amounts for your healthcare services.
Many beneficiaries favor Advantage plans due to their additional perks! For example, many Advantage plans offer dental benefits. But, insurance carriers are not required to provide this benefit. So, before enrolling in an Advantage plan, see if it includes any dental benefits. Please keep in mind that Advantage plans can change their benefits annually. So, if you enroll in an Advantage plan with a dental benefit, your carrier could omit that perk in the new year.
It’s common for Medicare beneficiaries to purchase a cost-effective, standalone dental plan. There are many dental plans that have no network restrictions and can offer a substantial amount of coverage. Contact a reputable Medicare broker today and see if they offer dental insurance to ensure you can take care of your dental health.