It’s important for people to get routine dental care throughout life, but especially in their senior years. Everyone should visit their dentist for regular check-ups and have regular cleanings. If you need fillings, extractions or more serious dental work, it’s better to have those procedures done early to avoid infection or complications.
If you will be eligible for Medicare insurance soon, you might be doing your homework to find the right coverage for your health care needs, and you might want to take dental care coverage into consideration.
As of now, Original Medicare Parts A and B don’t cover most dental care services, and beneficiaries pay 100 percent of the cost for routine dental care. On the other hand, many Medicare Advantage (Part C) plans offer enrollees extra benefits bundled together with the basic Parts A and B benefits. Many MA plans offer routine dental care coverage within their package of coverage.
What dental care services does Original Medicare cover?
Original Medicare Part A pays for some dental services that you might need while you are an inpatient in a hospital that accepts Medicare assignment. These dental services can include emergency or complicated dental procedures that require an inpatient hospital stay to resolve. To be eligible for this coverage, your admitting physician (who accepts Medicare assignment) must certify that the procedure is medically necessary and can’t be treated any other way.
Original Medicare Part A pays for your hospital stay and the procedure after you have paid your Part A deductible for the current benefit period. In 2023, the Part A deductible is $1600. Days 1-60 of your inpatient hospital stay have $0 coinsurance. After day 60, the coinsurance amount you are responsible for coincides with the number of days of your hospital stay.
How does Medicare Advantage (Part C) cover dental care?
As an alternative way to get Medicare coverage, Medicare Advantage plans bundle together all benefits offered by Original Medicare Parts A and B. Many Part C plans also include additional benefits like prescription drug (Part D) coverage, vision, hearing, and dental care. Some plans also provide fitness club memberships and other benefits as part of their coverage.
Because Medicare Advantage plans are sold by private insurance companies, they have the option to include extra benefits. They also set annual maximum spending limits for the amount you can spend for these extra benefits.
If you are considering enrollment in a Medicare Advantage plan you should research different plans in your service area to find one that offers the coverage that’s right for you. However, most Part C plans that include routine dental care services offer the following coverage:
- Routine dental examinations
- Dental cleanings
- Diagnostic examinations and services
- Restorative services such as fillings
- Endodontics – root canal treatment
- Treatments for gum disease and inflammation
- Tooth extractions
- Prosthodontics like crowns, dentures, bridges, etc.
Depending on the Medicare Advantage plan you have, your coverage might be limited to a certain number of dental services per year (one cleaning per year, for example). Your plan may also require that you use dentists or other health care providers that are included in the plan’s set network of medical providers and suppliers. Make sure you know who you can visit before making appointments or you might have to pay out of pocket for services.