Did you know that 26 percent of adults in the United States have untreated tooth decay? That 46 percent of all adults 30 years of age or older show signs of gum disease? Or that 95 percent of Americans regard their oral health as a critical part of their overall well-being?
Despite these statistics, many Americans don’t get the dental care they need, which is often especially important to those old to enough enroll in Medicare. But does Medicare cover dental procedures in the first place? This article will help answer all of your important questions.
Are Most Dental Services Covered Under Medicare?
According to the Medicare.gov website:
“Medicare doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.”
In other words, if you’re enrolled in Original Medicare (Part A, hospital insurance, and Part B, medical insurance), you’re responsible for paying 100 percent of dental services out of your own pocket.
The only exceptions to this are if you need emergency dental care (e.g., related to cancer) or must undergo complicated dental procedures (e.g., your jaw is crushed in an accident and requires reconstruction) while admitted to a hospital. And even if Original Medicare covers the emergency treatment, it likely won’t cover follow-up dental visits once the underlying health condition has been treated.
A good rule of thumb is that if it relates to dental services you receive primarily for the health of your teeth, Original Medicare likely won’t cover the related costs.
Is there any other way to obtain dental coverage under Medicare?
Do Medicare Advantage Plans Cover Dental Services?
Many Medicare Advantage (Part C) plans, which often take the standard coverages found under Original Medicare and expand upon them, frequently offer some level of coverage for routine dental care and related non-emergency procedures. Some Advantage plans even add coverage for prescription medications (Part D), eye care, and routine hearing, including hearing aids.
Related: How to Choose a Medicare Advantage (Part C) Plan
Advantage plans work a lot like traditional insurance policies, where coverage is provided by participating HMOs (health maintenance organizations), PPOs (preferred provider organizations), and POS (point of service) plans. As a result, you can expect different deductibles for dental care, as well as copays and coinsurance, depending on the specific plan you choose.
Related: PPO vs. HMO Insurance Networks for Individual and Family Health Insurance
However, it’s crucial to emphasize that not all Advantage plans cover dental care, so you’ll need to verify before signing on the dotted line if it’s important to you, based on your unique combination of needs, preferences, and budget.
Pro Tip: You’ll find details about the dental care offered under an Advantage plan by reading the “dental services” section. There, if you see the phrase “Medicare-covered benefits” listed, this means the plan might not add any coverage other than what’s provided under Original Medicare.
Which Dental Services Do Advantage Plans Cover?
While the dental services—if any—provided under a Medicare Advantage plan can vary widely, common options include:
- Teeth cleanings (prophylaxis)
- Diagnostic services
- Oral exams
- Routine X-rays
- Extractions (having your teeth pulled)
- Fillings and other restorative services
- Dentures (complete or partial)
- Root canals
- Treating gum disease and oral inflammation
Even if an Advantage plan offers a specific treatment, though, there may be sub-limits in place. For example, it may stipulate no more than two cleanings per year or just one extraction or one set of x-rays annually.
How Much Will You Pay For Dental Care Under a Medicare Advantage Plan?
In general, the more comprehensive dental coverage offered under an Advantage plan, the higher your monthly premiums.
It’s also worth noting that some Advantage plans come with annual limits, such as $1,500 for dental care over the course of a year. And if you exceed these maximums, you could end up paying out of pocket, so it’s always important to know what you’re getting for your money when calculating your overall budget.
For example, if Plan A comes with a lower premium than Plan B but also offers significantly lower annual limits, you might not get the most value for your hard-earned money.
With this said, plans with higher annual maximums will generally cost more than options with lower maximums.
Would You Like to Learn More About Medicare and Dental Care?
The friendly team at IHS Insurance Group has decades of combined experience helping clients like you with all aspects of Medicare, including dental care. Don’t hesitate to reach out if you have questions, and we’ll get back to you quickly with an answer you can count on!
Need a FREE Quote or have questions regarding Dental Insurance Coverage? We have three convenient ways to reach us:
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