Does Medicare Cover Dental? Here’s How Medicare Dental Plans Work…
Dental work is very important, your dental and oral health have ties to your overall health. Regular dental cleanings, let alone any surgeries or major work, can get quite costly so having Medicare dental coverage can be really useful for that. We’re often asked, “does Medicare cover dental?”
So, here’s everything that you should know about Medicare dental plans, how to get covered for dental with Medicare, which types of dental work are covered by Medicare, and everything else that you need to know.
Does Medicare cover dental?
The short answer is – no. Original Medicare (Part A and Part B) does not include dental coverage, however Part C can include dental (More on that in a moment!).
That said, if dental work is required as part of an emergency or complicated service, there may be some coverage. Procedures that are often covered by Medicare include:
- Dental extractions required to treat cancer involving the jaw or nearby soft tissues
- Preliminary oral examinations prior to heart surgery or kidney transplant
- Jaw reconstruction following an accident or injury
- Emergency or complicated dental procedures that require hospitalization
Coverage may fall under Part A or Part B depending on where the procedure was completed. In-hospital services fall under Part A whereas Part B covers medical services like doctor visits.
Original Medicare does not cover dental services like:
- Routine checkups
- Most dental extractions
Medicare Advantage Dental Coverage (Part C)
Medicare Advantage, otherwise known as Part C, is an “all-in-one” alternative to Original Medicare. Plans are available through private insurance companies and offer the same benefits as Medicare with the addition of a prescription drug plan.
Options will vary between providers and geographical regions, but many Medicare Advantage plans include additional benefits like vision and dental care.
While you may need to pay a monthly premium and other costs like coinsurance, the price you’ll pay is often comparable to Original Medicare. You can reduce costs by choosing a plan that meets your needs without unnecessary extras you won’t use.
Since most Medicare Advantage plans operate as a health maintenance organization (HMO) you will be limited to doctors and hospitals within your plan’s network. You can avoid this by choosing a plan that operates as a preferred patient organization (PPO), but there is often a higher cost associated with this.
What other options do I have for dental coverage?
If you don’t want to get dental coverage through Medicare, there are other types of plans you can choose from, including:
- Preferred Provider Organization (PPO)
- Dental Health Maintenance Organization (DHMO)
- Discount or Referral Dental Plans
Preferred Provider Organization
PPOs connect you to a network of dentists who have agreed to offer their services for a set fee. The type of services you receive will depend on what is covered through your plan, so you can shop for something that fits your needs and budget. You can usually use a dentist that is outside of your plan’s network, but there will be a fee attached.
Dental Health Maintenance Organization (DHMO)
DHMOs are similar to HMO plans, but with a focus on dental services. Like a PPO, these plans connect you to a network of dentists but instead of a set fee for services used, you will be required to pay a monthly set fee regardless of whether or not you see the dentist. Some services will be covered, while others will require you to pay a co-payment.
Discount or Referral Dental Plans
Discount or referral dental plans connect you to dentists who have agreed to offer a discount on their services. These plans do not pay for the services you receive. Instead, you will be required to pay for services used at a reduced rate as determined by your plan.
Other options that may work for you include: :
- Spouse or partner employer-sponsored insurance plan
- Medicaid (income qualifications will apply and vary by state)
- Local dental schools for free or low-cost services
Should I get a dental plan?
For many seniors, having a fixed-income can make it difficult to access necessary dental care. Dental conditions like periodontal disease and cavities are more common as you get older, increasing the importance of regular dental check-ups. As you can imagine, this can become costly if you have to pay for these services directly.
Dental plans can help eliminate the burden of expensive dental bills, but it’s important to know exactly what you are paying for. Ideally, you will want to look for a plan that covers costly services like implants, dentures, and bridges because they become more necessary as you age, and not all dental plans cover the cost.
Ultimately, the choice is yours to make. Dental plans do have costs associated with them, but they are often more affordable than paying for services directly, especially as the need for regular dental care increases. Luckily, there are options available and you should have no trouble finding a plan to suit both your needs and budget.
Why is dental care important?
Taking care of your teeth and gums is important for maintaining your overall physical health at any age. However, for seniors, it is especially important as medications, age-related health conditions, and decreased mobility and dexterity all impact oral health.
Poor oral health can lead to complications like:
- Tooth loss
- Periodontal disease (Gingivitis)
- Oral cancer
- Root disease
- Uneven jawbone
- Xerostomia (Dry mouth)
It’s important to note that some conditions, like periodontal disease, tooth loss, and dry mouth can be linked to other health complications like heart disease, pneumonia, and diabetes.
You can avoid or slow down the development of these complications by maintaining your oral health through regular dental care.
Aside from regular dental check-ups, cleanings, and oral exams, it’s recommended to:
- Brush your teeth twice per day with a soft-bristle toothbrush and toothpaste containing fluoride
- Floss once per day to clean between teeth
- Rinse your mouth using an antiseptic mouthwash once or twice per day
- If you wear dentures (full or partial) ensure they are cleaned daily
- Remove your dentures for at least four hours each day
- Drink tap water for the benefits of added fluoride
- Quit smoking if you are a smoker
- Eat a healthy, well-balanced diet including dairy and high-fiber foods
Final Thoughts on Whether Medicare Covers Dental
To sum it all up, Original Medicare will only cover dental emergencies, but there are certain Medicare plans that will include dental coverage to varying degrees, that you’ll need to get through private insurance companies, rather than via the traditional route.
Do you need help choosing which Medicare dental plan is right for you? We’re here to help you make the right decision, because let’s face it, Medicare can be downright confusing. It’s the type of thing that starts to make sense the more you do it, but most people will only need to shop around for Medicare plans once, so let us help you with the process and to take this extra burden off your shoulders so that you can focus on staying in good health, spending time with people you care about, and enjoying life.