Medicare is a program run by the United States government that provides health insurance for people over the age of 65, for people that are physically disabled, and for individuals that meet other particular criteria. If you are wondering, “does medicare cover dental expenses,” the short answer is that Medicare does not cover dental procedures.
In fact, the bill that made Medicare law specifically excludes coverage of the filling, cleaning, treatment, care, removal or replacement of “teeth or structures directly supporting teeth.” Not only does this exclude routine dental maintenance, this wording means that Congress has excluded blanket coverage for dental services. This means that most of the time Medicare will not cover dental procedures, even if you have a painful cavity or a very loose tooth. However, there are some instances in which the answer to the question “Does Medicare cover dental expenses?” is “Yes.”
One type of dental service that Medicare will cover is dental procedures that is an integral part of a procedure that is covered by Medicare. For example, if you injure your jaw in an accident and require jaw reconstruction, dental care needed to help fix your jaw will be covered. Medicare will also cover the removal of teeth before radiation of the jaw due to neoplastic disease (cancer). If you need to have a dental examination before you undergo a kidney or heart valve transplant, the answer to the question “Does Medicare cover dental in this situation?” is “yes,” but only if the examination is done as part of an inpatient hospital stay.
There are also some situations in which the answer to “Does Medicare cover dental?” is “Partially.” Medicare will cover hospital expenses that are incurred as part of very complicated or emergency dental work, which means that if you need to be hospitalized after a dental procedure, you will not need to pay anything for the resulting hospital stay. However, you will still be responsible to pay for the full cost of the actual operation.
There are a few other cases in which Medicare will pay for very particular dental services. If you need dental work to cover or reconstruct an oral ridge that is deformed due to the removal of a tumor that needs to be removed for medical (not dental) purposes, Medicare will cover that dental work. Medicare also covers all expenses if you need to have your teeth wired because of a jaw reconstruction. You can also have the insertion and removal of dental splints covered if it occurs as part of treatment for a covered medical condition, such as dislocated upper or lower oral joints.
If your dental service is covered by Medicare, does Medicare cover dental expenses no matter where you receive the procedure? As long as your procedure is done in the United States, yes. In most cases, dental services covered by Medicare are eligible for payment regardless of whether you have to be hospitalized or not before or after the procedure.
Medicare Advantage is one way that your Medicare coverage can be extended to cover dental work, but it is different than the original Medicare in many ways. Medicare Advantage is a program run by the government for Medicare-eligible individuals that subsidizes private insurance plans. This means that major health plans from providers such as Aetna are available to Medicare subscribers at greatly reduced rates. Many of these health plans include optional dental coverage which would cover most dental services. However, Medicare Advantage is different from Medicare in that there is a monthly cost to people who utilize this program and the benefits vary greatly from company to company.
If you are wondering, “does Medicare cover dental work” for your particular situation, the best way to get a definitive answer is to contact an official Medicare representative to get a definitive answer, because there is a lot of complexity and minutiae that goes into determining coverage benefits for Medicare.
In addition, the actual regulations governing Medicare can vary by state, so you are always better off talking to someone who can provide an official answer, especially because you may need to provide documentation to the professional performing your dental work. To contact a representative with your question, you can call 1-800-MEDICARE to speak to an official “Fiscal Intermediary” to answer and explain how Medicare would work for your situation.