How does Medicare cover dental treatment?

How does Medicare cover dental treatment?

Dental hygiene is an essential part of maintaining good health throughout your life. It becomes even more critical once you hit your 60s. Older adults are prone to oral conditions such as root and tooth decay, gum disease, tooth loss, and oral cancer. According to the Centers for Disease Control and Prevention, nearly 70% of older adults have gum disease. Also, more than 95% of adults 65 or older have at least one cavity. 

Although some dental conditions can lead to other health complications, Medicare doesn’t cover routine dental treatment and exams. However, there are a few circumstances when Medicare might pay for dental care.

Original Medicare’s dental treatment coverage

Original Medicare consists of Medicare Part A and Medicare Part B. These two parts cover your inpatient and outpatient medically necessary services. If the service or procedure isn’t medically necessary, meaning it isn’t needed to treat, diagnose, or prevent a medical issue, then Medicare won’t cover it. 

Although Original Medicare doesn’t cover routine dental services, such as dental exams, teeth cleanings, and root canals, it may cover dental services if needed to treat an underlying condition. For example, if you have oral cancer, Medicare may cover particular dental treatment if ordered by your oncologist as part of the plan to treat your oral cancer. These requested services would be medically necessary to treat an underlying health condition.

Another example where Medicare may cover dental services is if you are scheduled for surgery, and a dental exam is needed as a preliminary procedure to clear you for surgery. A common type of surgery that might include coverage for a dental exam is an organ transplant. Other than these few circumstances, Medicare does not cover dental treatment. 

Medicare Advantage plans’ dental treatment coverage

Medicare Advantage plans, also known as Medicare Part C, have to offer coverage as good as Original Medicare. However, Medicare Advantage plans can include certain benefits that Original Medicare doesn’t cover, such as routine dental services. 

Private insurance carriers sell Medicare Advantage plans, so each plan is different. However, most Medicare Advantage plans include routine dental services either for an additional monthly premium or already built into the plan. Depending on the plan, you may have access to both preventive and comprehensive dental benefits.

Stand-alone dental plans

Medicare Advantage plans are just one option Medicare beneficiaries have for their supplemental coverage. The other type of plan option is a Medigap plan. Medigap plans only cover what Original Medicare covers. If Original Medicare pays, then your Medigap plan will pay according to its coverage guidelines. 

Because Original Medicare doesn’t cover routine dental treatment, neither does Medigap. Medicare beneficiaries who have Medigap plans can look to a stand-alone dental plan for their dental coverage instead. Stand-alone dental plans are plans that usually cover just dental services. However, some plans include dental, vision, and hearing benefits. 

The premiums for these plans are generally based on age and aren’t limited to Medicare beneficiaries. Another thing to keep in mind about these plans is that there are typically waiting periods enforced for certain services. For example, depending on the plan, you may have a 12-month waiting period for any major dental services such as root canals, bridges, or crowns. However, you likely won’t have a waiting period for basic and preventive services such as cleanings and oral exams. 

Cash option

Even if you have dental coverage, the cash option may be more cost-effective. Depending on the type of coverage you have, asking for the cash price at your dentist rather than having them bill your insurance may save you money. Be sure always to ask what the cash estimate is for any services you plan to get. Then compare that to your dental benefits to see which is the more cost-effective option.