Does Medicare Cover Dental? Top 3 Things You Should Know
Thirty-seven million Medicare beneficiaries have no dental coverage and spend an average of $922 on dental bills.
There are many reasons for this phenomenon, not the least of which is improper coverage. Choosing a plan that doesn't provide for all the procedures you need isn't a wise decision.
A lack of knowledge also leads people to accept the wrong plans or to not apply for supplemental insurance that could help them.
Applying for and managing Medicare can be a complex process. There are so many plans available with different coverage options and prices that it's difficult to choose between them.
Knowing the basics of what your plan pays for helps ensure you get all the care you require. That's why you should be aware of every procedure your policy does and does not cover ahead of time to avoid a nasty surprise when it's time to pay.
You may be wondering, does Medicare cover dental services? If not, how can I ensure I can still get the care I need?
Read our guide to learn what Medicare covers and how to navigate your changing plan options.
1. It Depends on the Procedure
Like almost any form of medical insurance, Medicare won't be held responsible for every procedure you undergo. Part A is for hospital care, Part B is for outpatient services, and Part D is for prescription drugs.
Despite this, it's important for you to know if Medicare will cover your dental procedures before you undergo them. You must know when and why it would cover the costs of a procedure.
What It Covers
Medicare is meant to provide for the costs of serious medical procedures and doesn't always cover everyday care and preventative procedures. This is also true of dental care.
Medicare and dental work tend to only work together when there's a serious medical condition involved. It must cover the cost of:
Removing teeth before radiation treatment for neoplastic disease
Oral examinations that are part of renal transplants or heart valve replacements
Dental extractions for jaw cancer
Jaw reconstructions after accidents or injuries
If any dental procedure becomes part of a serious condition requiring hospitalization, it may also be covered under Medicare. Otherwise, the beneficiary usually has to pay the costs out-of-pocket.
There are ways to reduce the amounts you pay. Medicare Part A may help reduce costs if you receive dental care in a hospital, but you're 100% responsible for the costs of most outpatient care.
What It Doesn't Cover
Medicare will not cover everyday dental services such as cleanings or checkups. These are considered non-essential and are typically performed outside of a hospital, meaning you'll be responsible for the costs.
If you're aging and beginning to lose your teeth, you may be wondering, will medicare cover dentures? The answer is a strong no.
Dentures are considered an everyday, non-emergency service, meaning they won't be covered by Medicare. Even if you require dentures as part of a serious procedure such as surgery, Medicare will not cover the cost.
You'll usually get a "no" if asking a provider a question like "does Medicare cover dental procedures?" It typically only covers the most extreme circumstances. Most procedures you'll undergo require you to make out-of-pocket payments.
2. It Depends on the Type of Plan
Part of what makes Medicare so confusing is the various different types of coverage it offers. It's tough to sort through all the different parts and options and determine how they're different and what types of services they cover.
Comparing different types of plans lets you know which services will be covered. The major types include traditional Medicare, Medicare Advantage, and Medigap.
Traditional Medicare
Original or Traditional Medicare refers to both Part A and Part B. It covers hospital or hospice care, preventative care such as doctor's visits or tests, and outpatient services.
These traditional plans are the most limited in terms of dental coverage. They typically only pay for the costs of serious procedures or hospital care.
Medicare Advantage
Medicare Advantage, also known as Part C, limits out-of-pocket costs to $6,700. The exact terms differ depending on the provider, but some allow you to get dental insurance through Medicare.
One-third of Medicare beneficiaries, a group of 22 million people, are enrolled in a Medicare Advantage plan. Sixty-two percent of them had a plan that included dental benefits, compared to only 21% that bought stand-alone dental coverage.
The major disadvantage of these plans is they tend to be private and restrict which providers you can receive care from. To receive Medicare dental services, you'll have to go to a dentist in the right network who accepts your insurance.
Medigap
Medigap coverage is a supplemental form of insurance designed specifically to add to the provisions of Medicare. Beneficiaries can add it to their existing Medicare coverage for extra protection, reduced costs, and more.
Not all Medigap plans are created equally, so choose carefully. Look for a plan that includes coverage for dental services to reduce the cost of dental insurance with Medicare.
With Medigap coverage, you may have to pay added premiums. There may also be restrictions on which providers you can see, just like with Medicare Advantage plans. If you can handle these disadvantages and want more coverage, consider the plan.
These are only some of the different types of Medicare plans available today, and more varieties are sure to spring up as needs and laws adapt to patient problems. Choosing the best one is critical to ensure you get coverage for the care you need.
3. It Can Change at Any Time
If you find yourself stuck with the wrong plan that doesn't provide all the coverage you need, it's not difficult to change it.
Make sure you enroll in a new policy or change your current one at the right time and know the basics of what you're signing. This is the best way to get a plan that perfectly suits your needs.
Enrolling at the Right Time
There's more than one enrollment period for Medicare. Consider initial, special, general, and annual enrollment.
Initial enrollment, as the name suggests, is for beneficiaries applying for the first time. The time your coverage begins depends on when you apply.
Enrolling the month of your 65th birthday is the fastest way to get coverage. This means you'll become a Medicare beneficiary the next month.
Enroll the month after your birthday month and your coverage will start in 3 months. Enroll 2 months after and it extends to 5 months. Enroll 3 months after and it extends to 6 months.
Enrolling during initial enrollment also helps you get supplemental insurance regardless of health conditions.
Special enrollment periods apply to anyone in circumstances that might affect their ability to apply during initial enrollment, including:
Moving to a new house
Leaving or losing a job that provided you with insurance
Contract changes with your current plan
Eligibility changes
The rules for applying in these circumstances change how and when you can get covered as well.
General enrollment occurs between January 1st and March 31st every year. Everyone who applies in this time period gets covered starting on July 1st of that year. If you choose general enrollment, add Part B to avoid an ongoing fine.
Annual enrollment is the best time to consider making changes to the plan you already have. It occurs every year between October 15th and December 7th.
Annual enrollment is the only time you can enroll in Medicare Advantage or Part D plans, so take the opportunity to get the coverage if you need it.
The only exceptions are special circumstances and Medicare Advantage's Open Enrollment Period from January 1 to March 31 that lets beneficiaries who already have an advantage plan drop it or switch to a new one.
Knowing the Law
Keep in mind that the legal policies that determine what Medicare is and isn't required to cover change frequently. They also differ from country to country and state to state.
Stay up-to-date on the current coverage requirements in your area. Do your research and communicate with professionals who understand Medicare.
Make sure you know all your options before making any final decisions that could affect your medical care for the rest of your life. Choose the best plan that includes coverage for all procedures you need, including dental care.
Does Medicare Cover Dental and Where Can I Get a Plan That Does?
Medicare can be a confusing monster requiring a mess of paperwork. Failing to understand it can leave you in a financial hole when trying to receive the medical care you need. The best way to avoid this is by knowing what your policy covers.
The simplest answer to a question like "Does Medicare cover dental?" is this: It depends. The procedures you undergo, the plan you currently use, when you enroll, and how well you know the law all affect how much you'll have to pay.
Getting the best possible Medicare plan ensures you can get the highest level of care and all types of procedures you may require. It should cover or reduce the costs of everything from dental to eye doctor appointments. Explore your plan options today.
