Oral health is an important concern for seniors, as dental disease is a common cause for many doctor and emergency room visits. Yet, only 29% of seniors age 65 and over had dental insurance in 2017, according to the Centers for Disease Control and Prevention (CDC).
That’s a worrisome statistic, considering that 68% of seniors have gum disease according to the CDC. Here’s what you should know about Medicare and dental treatment.
Will Medicare cover my dental work?
Medicare only covers services that are considered medically necessary, and unfortunately, under Medicare guidelines, dental care does not fall into the medically necessary category. Routine dental care and most dental treatments are not covered by Medicare.
Dental surgeries
Tooth extractions are one of the most common dental surgeries among seniors. Medicare doesn’t usually pay for extractions, however, they may cover the procedure if it is necessary to prepare the jaw for radiation to treat cancer, for example.
Medicare may also cover restorative surgery in certain circumstances. For instance, if a cancerous tumor needs to be removed in the face or mouth and the area must be reconstructed, Medicare will likely cover the procedure.
Corrective dental surgery is another common dental surgery to treat fractures in the face or jaw. If this is the case, you will likely require dental splints or wiring to help you heal properly. Medicare generally covers this procedure because it’s considered medically necessary.
Keep in mind, once your doctor treats your condition, Medicare will not cover any follow-up dental services or exams regarding your dental work. If you go in for follow-up care, prepare to pay 100% of the bill.
There are some surgeries Medicare almost never covers, such as root canals and dental implants. Even though you must undergo surgery for root canals and dental implants, Medicare does not consider these procedures to be medically necessary.
How can I get dental benefits?
Since Original Medicare does not provide routine dental benefits, many beneficiaries seek Medicare alternatives, such as Medicare Advantage plans. In 2020, 88% of Medicare Advantage plans offered dental coverage, according to Medicare Resources. If you want to continue your routine dental cleanings and exams, you might appreciate this benefit.
Medicare Advantage plans
Although Medicare Advantage plans change their benefits frequently, most plans for routine dental services. Keep in mind that most Medicare Advantage plans have provider networks and your favorite dentist might not participate. Standalone dental plan
People enrolled in Original Medicare with or without Medigap often purchase a stand-alone dental plan. Many dental plans cover teeth cleanings, crowns, fillings, x-rays, and root canals. With that said, dental insurance companies do not change their benefits, unlike Medicare Advantage plans, making these plans a reliable option for senior citizens.
Conclusion
Even though Original Medicare does not cover routine dental services, you have options to help you pay for dental care. A licensed Medicare broker is a great source of information to help you find the right plan for your situation.
