The short answer is no (most of the time). Original Medicare does not cover most dental procedures unless they are considered Medically necessary, or they take place while you’re admitted to the hospital.
As one expert puts it, “These omissions have been in place since Medicare was created in 1965, so it’s not as if some new problem has emerged. What has become clearer, however, is that huge and growing numbers of seniors face substantial dental, hearing and vision expenses.”
For example, when you’ve been admitted to the hospital, and you need a dental exam before a procedure can be done, that would be covered. In another case, if you had a major injury, like a car accident where your jaw or teeth needed work, that would also be covered.
Things like cleanings, fillings, and tooth extraction are not covered as they are usually elective procedures. Original medicare does not cover routine and preventive dental work, so it’s up to you to cover the cost of that yourself, either out of your own pocket, or with a separate insurance plan that covers routine work.
Medicare Advantage Dental Coverage
Your Medicare Advantage plan however, may offer options for routine treatment of dental issues, as well as annual or semi-annual cleaning. All of this depends on the specifics of the plan you’re enrolled in, as no two plans are the same.
If you currently have a Medicare Advantage Plan and you’re considering switching plans during your annual enrollment period, make sure that your plan has the level of dental care that is important to you.
However, if you’re currently on a Medicare Supplement plan, and considering switching to a Medicare Advantage plan in order to get better dental benefits. The out of pocket costs and security you’d be giving up from your supplement far outweigh whatever dental benefits you’d be receiving with an Advantage plan.
There’s a better option available that can save you money, and lets you keep the security of your Medicare Supplement.
Other Options for Dental Coverage
That doesn’t mean you’re out of luck if you don’t have dental coverage through Medicare. There are other options, and they probably won’t cost you as much as you think.
Try a Separate Dental Insurance Policy
Most insurance companies offer separate dental policies that take care of the routine costs and procedures that come up. Not all plans may be available in your area, but there are plenty of options available.
Typically these plans allow for regular cleanings, and have a scheduled amount available for certain procedures like tooth extractions, root canals, and more.
The best part is, these plans are much more affordable than you might think.
Contact us today to learn more about your options for Dental Care
Does Medicare cover dental implants?
Original Medicare does not cover dental implants. Even though this is a surgical procedure, it falls under the routine dental care category and isn’t covered by your Original Medicare benefits or your Medicare Supplement Plan.
If you’re on a Medicare Advantage plan, you should check your policy information or ask your insurance company for your specific benefits.
However, a stand alone dental insurance policy will cover most if not all of the cost of a dental surgery, as well as other regular dental care.
Does Medicare cover dentures?
Unfortunately original Medicare does not cover dentures in any situation. This falls under the routine and elective procedures that Medicare does not cover with Part A or B.
A Medicare advantage plan may offer denture options, but be sure to check with your plan’s insurance company to see what your copayment will be.
Typically dentures can run as high as $3200 without any insurance, so unless you’ve got a separate dental policy, you could run into a really pricey situation.
Does Medicare cover braces?
Original Medicare does not cover braces. These are classified as elective, and in general, Original Medicare doesn’t pay for anything that could be considered a cosmetic procedure.
This is a pretty ironclad rule. Unless something is deemed “medically necessary” Medicare won’t cover it.
The cost of braces out of pocket can vary wildly from state to state, and it’s also highly dependent on who your orthodontist is. The range is anywhere from $3,000 all the way to $10,000. It’s not uncommon for providers to offer a cash discount. Ask your dentist if they do the same.
A Medicare Advantage plan, while it may offer you some extra dental benefits along with your medical policy, will end up costing you thousands of dollars in out of pocket costs before you reach your out of pocket maximum.
Does Medicare cover Invisalign?
Just like Original Medicare doesn’t cover regular braces, it definitely does not cover Invisalign. This would fall under the category of a cosmetic and elective procedure, so Medicare would not deem the procedure medically necessary.
Typically the out of pocket cost for Invisalign braces can range anywhere from about $2,000 all the way up to over $9,000.
Some standalone dental policies will cover some of the cost with a copay or a coinsurance payment.
Does Medicare cover tooth extraction?
Other than extreme emergencies, where deemed medically necessary, Medicare does not cover tooth extraction. Regardless of the pain that may come up, an extraction is almost always classified as an elective procedure.
Without coverage, you’re probably looking at around $200 on average for a tooth extraction, possibly more depending on how complicated the process is, and if the tooth is damaged.
Does Medicare cover root canals?
No, Medicare does not cover root canal surgery. A lot of people have a false impression of the root canal procedure, thinking that it’s a highly sensitive and difficult surgery. If you’re like most people, you’ve probably heard a joke or two about the pain and discomfort involved.
Still, it’s classified by health insurers and Medicare as a routine procedure. Millions of root canal surgeries are done each and every year, and they’re usually considered an elective procedure except in extreme cases. As was stated above, if you’re admitted to the hospital, and it’s determined that a root canal is necessary, then it will be covered. Otherwise you’ll be forced to cover the cost out of your own pocket, or with a separate dental policy.
If you’re enrolled in a Medicare Advantage plan, it’s very possible you have routine dental coverage, including for a root canal procedure. Consult your policy documents or the agent who sold you the policy.
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