Dear Jane,
My mother needs to have dentures made and Medicare is her primary insurance. Does Medicare cover dental?
-Reba
Dear Reba,
Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings, or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have teeth pulled (extracted) as preparation for a medical procedure, Medicare will not cover the cost of implants or dentures (complete or partial/bridge); you will be responsible for the full cost.
Note: Some
Medicare Advantage Plans cover routine dental services. If you have a Medicare Advantage Plan, check with your plan to see what dental services may be covered.
However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare covers to be successful.
Medicare will pay for dental service, for example, if
- you receive an oral examination in the hospital because you will be having a kidney transplant or in a rural or federally qualified health clinic before a heart valve replacement;
- you have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
- you had a facial tumor removed and had ridge reconstruction (reconstruction of part of the jaw) as part of that procedure;
- you need surgery to treat fractures of the jaw or face;
- you need dental splints and wiring as a result of jaw surgery.
While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated. For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.
Medicare will pay for some dental-related hospitalizations, for example, if
- you develop an infection after having a tooth pulled;
- you require observation during a dental procedure because you have a health-threatening condition.
Note: Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.
While Medicare may pay for in-patient hospital care in these circumstances, Medicare will never cover any dental care specifically excluded from
Original Medicare (i.e, dentures), even if you are in the hospital.
-Jane
This information is republished with permission from the Medicare Rights Center. For more info visit
www.medicarerights.org
.
Sincerely,
Jane Bohn, CSW
Director of Social Services
If you or someone you know has a question for Jane please send her an email at
jane@riverviewestates.org and remember to put "ask Jane" in the subject line.