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:
- AARP MedicareComplete
- Humana Medicare Advantage plans
- WellCare Medicare Advantage plans
- Blue Cross Medicare plans
- HealthSpring Medicare plans
- and many other regional plans
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.