Does Medicare Cover Wisdom Teeth Removal? 

Wisdom teeth, so named because they usually emerge between ages 17 and 21, help with chewing. They may appear with only mild discomfort. Problems occur, however, when the space in your mouth cannot accommodate them. Wisdom teeth can also break through the gums in the wrong position.

The American Dental Association (ADA) recommends the removal of wisdom teeth that cause pain, infection, tooth decay, gum disease, tumors or cysts. While some people undergo extraction as young adults, others carry their wisdom teeth into later years. The ADA suggests monitoring if removal is not necessary. As you grow older and develop age-related health conditions, you may also encounter issues with your wisdom teeth.

Medicare dental coverage

Original Medicare does not generally cover dental care but may help with the cost of specific dental services related to covered medical benefits. For example, Medicare will cover medically necessary tooth extractions before radiation for jaw-related neoplasm (abnormal tissue growth). Part A covers emergency dental work and complex dental procedures in the case of hospital admittance. 

If you require hospitalization, Part A covers inpatient hospital services, including dentists on the hospital staff. Your cost is the Part A deductible for each inpatient hospital benefit period. If you stay longer than 60 days, you also pay a coinsurance for each day you remain hospitalized beyond 60 days in a benefit period. Part B pays 80% of Medicare-approved physician charges for services performed during your stay.

You may have help paying the Part A deductible if you have Medigap.  Medicare Supplement plans cover 100% of the Part A coinsurance. 

Medicaid dental coverage

Medicaid is a federal program administered by the states to provide healthcare access to people with limited means. Eligibility standards vary by state, and states have the authority to decide whether or not adults enrolled in Medicaid will have dental coverage. According to Medicaid, most states will cover adult emergency dental services. Less than 50% of states offer comprehensive dental to adult enrollees.

All state Medicaid agencies have to give children dental coverage to children in the Medicaid program and the Children’s Health Insurance Program (CHIP). At a minimum, dental care for children must include pain and infection mitigation, teeth restoration and dental maintenance.

Dental coverage alternatives 

If you want dental coverage, search for a Medicare Advantage (MA) plan that offers dental benefits. MA plans often provide extra benefits that include dental, hearing, vision, fitness and other services not covered by Original Medicare.

Similar Posts