Medicare Dental Coverage

Medicare Dental Coverage

Although Medicare covers a large number of medical related services, it does not provide coverage for many items that are considered to be “routine” such as eye exams and foot care. This also includes most dental care and dentures.

Neither Medicare Part A or Part B covers most routine dental care or dental supplies. This includes regular dental procedures such as cleanings, fillings, and tooth extractions. It also encompasses dental plates, dentures, and other types of dental devices.

In fact, even if Medicare has paid for you to have your teeth extracted (pulled) in order to prepare for another medically necessary procedure, Medicare will not pay for the cost of dentures as a result of this procedure.

What Types of Dental Procedures Will Medicare Pay For?

In certain instances, Medicare will pay some coverage for dental services if such services are needed for the protection of your general health. Medicare may also pay for some dental care if you need it for another health care service that is covered by Medicare.

Some examples may include the following:

  • You have a disease, such as oral cancer, involving your jaw and you need dental services that are needed for radiation treatment
  • You require surgery in order to treat fractures of the face or jaw
  • You require wiring and / or dental splints as the result of having surgery to your jaw
  • You have had the removal of a facial tumor and had jaw reconstruction as a result of that procedure

Medicare typically only pays for dental services that are considered to be an integral part of another covered procedure. As an example, Medicare may cover the reconstruction of an individual’s jaw following an accidental injury or for tooth extractions that are done in the preparation for radiation treatment for other diseases that involve the jaw.

In addition, it is possible that Medicare may pay for certain types of oral exams – but not for treatment – prior to major procedures such as heart valve replacement or a kidney transplant, under various circumstances.

These exams would be covered under Medicare Part A, if they were provided by a dentist on staff at a hospital. They would conversely be covered under Medicare Part B if the exams were performed by a physician.

Although Medicare may cover some of these services, it will not pay for any of the follow up dental care that is required after the particular health issue has been treated. As an example, if you had a tooth pulled prior to surgery from a facial injury in a auto accident, Medicare will not cover the cost of any follow up dental care that is needed in the future due to having that tooth removed.

Dental-Related Hospitalization Coverage

There are some circumstances where Medicare may pay for some dental related hospitalization costs. These could include the following:

  • You have developed an infection due to having a tooth extracted (pulled)
  • You have a health-threatening condition during a dental procedure that requires you to be under a doctor’s observation

It is important to note that although Medicare may cover the expenses of hospitalization – which includes your room and board, x-rays, and anesthesia – Medicare will not typically cover the fee for the dentist, as well as the fees of the other dental professionals such as the anesthesiologist and / or the radiologist.

In addition, even though Medicare may pay for certain in-patient dental-related hospital care in various instances, it will not ever pay for any type of dental care that is specifically excluded from Original Medicare (Medicare Parts A and B) – even if you have received such care while you are in the hospital.

Other Ways to Obtain Dental Coverage Through Medicare

Although many dental services are not covered under Original Medicare (Medicare Parts A and B), such services may be covered under a Medicare Advantage (Medicare Part C) plan. Many of these plans offer coverage that is in addition to that of Original Medicare.

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