Does medicare cover dental fillings?

Medicare doesn't cover most dental care (including procedures and supplies such as cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices). Part A covers inpatient hospitalizations, skilled nursing facility care, hospice care, and some home health care. Dental coverage is not automatically included in Medicare coverage. Original Medicare (Parts A & B) does not include dental services such as routine exams, extractions, fillings, or x-rays.

Only a small list of medical emergencies is covered. Many Medicare Advantage (Part C) plans include dental insurance, but you may have to pay a higher premium. Alternatives include purchasing a separate dental policy from a private insurance company or enrolling in a dental discount plan to reduce your out-of-pocket costs. We chose Aetna as the best option for nationwide coverage of its operations in all 50 states.

Aetna has approximately 12.7 million dental members and its network includes approximately 1.2 million healthcare professionals, with more than 700,000 doctors and primary care specialists. Yes, but Medicare Part B only covers dental expenses that are a medically necessary part of another covered service. It doesn't cover routine dental services, such as cleanings or other standard procedures, such as dentures, crowns, or fillings. Parts A and B of Original Medicare‡ do not cover dental care, except in certain circumstances.

For example, if you are in the hospital for dental surgery, Part A will cover hospitalization costs. For other dental care, such as dental cleanings and root canal treatments, you will pay 100% of the cost. Among the nine plans that offer the broadest dental services, five of the plans charge coinsurance, each of which is subject to an annual plan limit, with coinsurance ranging from 20% to 70% depending on the service, and 50% is the most common coinsurance amount across all service categories. The “Plan Details” button helps you learn more about the coverage offered, such as preventive dentistry (exam, cleaning, x-rays) or comprehensive dental (extractions, periodontics, restorative services).

You can also use FAIR Health's consumer cost lookup tool to get an estimate of the amounts dental professionals typically charge in your area for different services. You can purchase dental and vision packs to supplement Original Medicare‡, Medicare Supplement, or Part D (prescription drug) plans. We focus on Medicare Advantage plans because they have become the primary source of dental coverage among Medicare beneficiaries. Most Medicare Advantage members have access to broader benefits and the majority (78%) of these members are in plans that impose an annual dollar cap on the amount the plan will pay for dental care.

Good resources include the State Health Insurance Assistance Program at 877-839-2675 or calling Medicare at 800-MEDICARE (800-633-422) for answers to questions that haven't been answered in your research. With the Medicare Find a Medicare Plan tool, you can log in without an account, choose a Medicare Advantage plan, enter your zip code, and follow the simple instructions to get a list of available plans. Anthem Blue Cross and Blue Shield is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. These most common coinsurance amounts for basic and routine dental coverage are the same as those for Medicare Advantage plans for broader services (50% coinsurance), although most Medicare Advantage plans don't charge a deductible first.

Also, keep in mind that there is a difference between restorative dental services, such as dentures and crowns, and cosmetic dental work, such as teeth whitening. .

LaDonna Byrne
LaDonna Byrne

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