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Medicare Dental Benefits Reviewed

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Smiling Dentist and AssistantWhere are my Medicare dental benefits?

If you have asked this question, you are not alone. Many people who have become Medicare eligible have either been surprised or dumb founded to learn that for the most part Medicare dental benefits are nearly non-existent.

In fact there are very few circumstances when Medicare will cover dental procedures.

When Medicare was first created it was not intended to be comprehensive health coverage. The Medicare legislation also included a statutory dental exclusion.

This exclusion states that:

“where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.”

In 1980 the exclusion was amended to allow for Medicare dental benefits for inpatient hospital services when the dental procedure itself made hospitalization necessary.

Medicare will also pay for dental services that are part of a covered expense. This could include reconstruction of the jaw due to an injury. Medicare dental benefits are also available for the extraction of teeth related to radiation treatment and in some cases will pay for an oral exam (but not treatment) prior to kidney transplants or heart valve surgery.

Medigap will not cover routine dental care

Many people believe that purchasing a Medicare supplement will give them¬† dental benefits, but this is not the case. Medigap, or Medicare supplemental insurance as it is known, will fill the gaps left by Medicare. Filling the gaps means paying the beneficiary’s portion of Medicare charges, not providing additional benefits.

The only opportunity to receive Medicare dental benefits beyond what is allowed due to a hospitalization, is to enroll in a Medicare Advantage plan that includes dental benefits. A Medicare Advantage plan is also referred to as Medicare Part C.

Medicare Advantage plans are available from private insurance companies that are approved and contracted with CMS to administer your Medicare benefits.

Some popular plans that include dental benefits are:




Medicare Advantage Plans – Top 5 Benefits

If you are interested in finding Medicare plans that include dental benefits, you can shop online or visit the Medicare website and navigate your way to plans in your area. A Medicare Advantage plan is currently the only way to receive Medicare dental benefits.

Save 10%-60% on your Dental Care!

5 comments

  1. I have a Medicare Advantage plan and got a dental plan seperately. I would like to change my dental plan from the HMO plan to a PPO plan. The carrier that I am with do not have a PPO plan at this time. Can I change my dnetal plan to another carrier who has a PPO plan?

  2. Thelma, If your dental plan is indeed separate you should be able to change plans as your Medicare Advantage Plan has no bearing on your dental. But if you mean separate as in an additional rider to the Advantage Plan you will not have an option.

  3. I just want to know if Medicare pays for gas at the dentist.I need alot of work done and CAN NOT do it without gas….
    Thank you for your time……

  4. Lucinda, Original Medicare offers very little in the way of dental benefits. Unless your dental work requires hospitalization you most likely will receive NO benefit from Medicare. Here is an article on Medicare dental.

  5. I am totally disgusted with all of the medicare part d plans.
    I have SEVERE tooth decay to where my teeth are breaking off at the gum line. I am disabled and have been on so many medications all of my life, that I am sure it has something to do with that, or a calcium problem possibly. My husband and I barely make it from one month to the next on our disability payments. I worked for almost 20 years of my life even through
    several spinal surgeries. I have numerous congenital spinal disorders that flaired up when I was only 13-14 years of age. I had my first surgery at the age of 19. I am now going on 55 and I had beautiful teeth until about a year and 1/2 ago when i noticed gaps starting by the gumline. Then this black stuff started around the gums and my teeth became week and started chipping and breaking off. I don’t even want to smile anymore. Currently I only have3 top teeth that haven’t broken off, but are ready to, my bottom teeth are doing the same. Please send me some advise as to how I can get them fixed. The plan we are currently on is Universal and they cover 1 cleaning a year, x-rays and up to 3 extractions. I can barely eat anymore without the pain being so bad or having to tear my food or cut it into child size pieces. I believe there has got to be a dentist out there that has a heart and doesn’t care just about the cost. The one I went to wanted $3,000.00 just for dentures, it did not include the oral surgeon I needed to remove the broken off teeth, etc. Due to the condition of my spine I am unable to lay flat. I sleep in a recliner, so they said I would need special care, be put to sleep, etc. to have these removed. Just a quick run down on my spinal problems, I have spinal stenosis, od course degenerative disc disease, spondylothesis (not sure of spelling), bone spurs (osteophytes) from my neck down a slight scoliosis and severe kyphosis. I have metal plates, bars, screws (that look like they could fit on a semi truck)and cages they put in through the front of my spine. I was in that (my 7th) surgery for a little over 17 hours.
    SOMEONE OUT THERE CAN HELP ME I KNOW. PLEASE.
    YOURS TRULY AND THANKFULLY
    CINDY MOODY

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