Does medicare pay anything on teeth?

Medicare doesn't cover most dental care (including procedures and supplies such as cleanings, fillings, tooth extractions, dentures, dental plaques, or other dental services). Original Medicare doesn't cover most dental care and there are no Medicare dental plans to buy. If you're looking for coverage for routine dental services, such as teeth cleaning and x-rays, and more specialized treatments for fillings, extractions, dentures and more, Original Medicare doesn't cover those dental services. However, there are ways to get dental coverage in some types of Medicare plans.

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. In addition, while Medicare may cover inpatient hospital care in these cases, it never covers dental services specifically excluded from Original Medicare (such as dentures), even if you are in the hospital. One of the plans requires copayments for broader dental benefits that vary by service category (no annual maximum specified).

We focus on Medicare Advantage plans because they have become the primary source of dental coverage among Medicare beneficiaries. Some Medicare beneficiaries have access to dental coverage through other sources, such as Medicare Advantage plans, but the scope of dental benefits, when covered, varies widely and is often quite limited, which can lead to high out-of-pocket costs for those with serious dental needs or not satisfied. So, even with a very strong health plan through Original Medicare+Medigap+ Part D prescription drug coverage, dental care is an out-of-pocket expense. For example, if you were in a car accident and needed a tooth extraction as part of surgery to repair a facial injury, Medicare may cover the extraction of your tooth, but it will not pay for any other dental care you may need later because your tooth was removed.

Lawmakers are now discussing options to make dental care more affordable by expanding dental coverage for people receiving Medicare. In fact, approximately 24 million Americans who receive Medicare do not have dental insurance that covers these services. If this is important to you, you can contact your elected representatives to urge them to work to add dental benefits to Medicare. Medicare Advantage plans that offer dental coverage may require members to receive all covered services from in-network dental providers or to impose additional cost-sharing for out-of-network services.

While Medicare doesn't pay for dental care needed primarily for the health of your teeth, it does offer very limited coverage for dental care needed to protect your general health or for dental care needed for another Medicare-covered health service to succeed. Given the continuing interest in adding a dental benefit to Medicare, legislators will need to weigh a variety of factors when designing this benefit, including the scope of covered benefits, the cost-sharing of specific services, and how different levels of dental coverage can affect Medicare costs and premiums. Virtually all Medicare Advantage members in plans that offer access to dental benefits (even if they have to pay a premium for those benefits) have access to preventive services, including oral exams (100%), cleanings (100%), and x-rays (99%), although fewer members have access to fluoride treatment (59%). Services such as cleanings, fillings, tooth extractions, dentures, dental plaques, and regular dental visits are not covered by Medicare Part B or Part A.


LaDonna Byrne
LaDonna Byrne

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