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Dental Coverage under Medicare 

There is very little coverage for Dental Under Medicare

 

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. In rare cases, Medicare Part B Doctor Visits will pay for certain dental services.  In addition, Medicare Part A Hospital will pay for certain dental services that you get when you are in the hospitalmedicare.gov/dental

Some Medicare Advantage plans may include dental benefits.  See the Quote boxes on the right or scroll down to get a separate dental policy. 

We did not in our research find any coverage under Medicare for Accidents!

Medicare will pay when

  • 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; See TMJ below
  • 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.

Learn more ⇒

medicare inter active.org/

medical necessity

CMS General Explanation

Justice in Aging – Oral Health for older Americans

Medical Loss Ratio – Insurance Companies must pay out 80% of what they take in in premiums.  If they are going to pay for Dental Implants, how much do they have to charge?

Exclusions

partnership for solutions.org

Coverage Determinations cms.gov   –

Dental Exam prior to Kidney Transplant 260.6

Medicare Policy Benefit Manual cms.gov

Exclusions  cms.gov

2021 #Budget Bill to Add Dental???

H.R.502 – Medicare Dental Benefit Act of 2021

HR 4311 Medicare Dental, Vision, and Hearing Benefit Act of 2021 

 

2022 US Government BudgetImproving Medicare, Medicaid, [Medi Cal]  and ACA Coverage. Medicare, Medicaid, and the ACA marketplaces provide critical coverage to tens of millions of Americans, but should be strengthened through measures like improving access to dental, hearing, and vision coverage in Medicare, making it easier for eligible people to get and stay covered in Medicaid, and reducing deductibles  for marketplace plans [Covered CA].

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S. 97/H.R. 502, would repeal the statutory exclusion on Medicare coverage of dental care and dental prostheses, while creating a specific dental benefit under Medicare Part B.

Specifically the bill:

  • Repeals the statutory exclusion on Medicare coverage of dental care and dental prostheses.
  • Expands Part B benefits to cover dental and oral health services, including
  •  
  • routine cleanings and exams,
  • fillings and crowns,
  • major services such as root canals and extractions,
  • emergency dental care, and
  • other necessary services.
  • Provides for payment of dental prostheses, including crowns and full and partial dentures.
  • Gradually phases in benefits over an 8-year period.
  • Ensures adequate reimbursement for dental providers who serve low-income enrollees.
  • Requires that the United States Preventive Service Task Force (USPSTF) include at least one oral health professional. Barragan *
  • Coverage likely to be similar to what is included now in Medicare Advantage MAPD… note MAPD plans generally have the option to add more dental benefits…

 

References & Links

 

Oral Health for Seniors

Justice in Aging - Advocates Guide

oral health seniors

 

Dental For #Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

VSP Vision Enroll ONLINE

#TMJ, which related to trauma (such as a blow to the face),

might be covered under Original Medicare.

.

Treatment efforts for TMJ are directed toward:

1) reduction of pain,

2) improvement of dysfunction,

3) slowing the progression of the joint disease.

Temporomandibular joint arthroplasty is usually attempted after all nonsurgical methods of treatment have failed (AAOMS, 2001).

Conservative therapy is the mainstay in treating TMJ. This therapy may include behavior change, oral medications for pain, anti-inflammatory injections, and orthotic devices. Surgical treatments, often irreversible, may be recommended for difficult or unresponsive cases.

Learn more

Resources & Links.
 
 

There is NO Pre existing condition clause in Medicare or Medicare Advantage Plans

Instant Dental Quotes

Federal Law on Medicare – Part A  law.cornell.edu/

Part B  aw.cornell.edu

(D)in the case of inpatient hospital services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services;  law.cornell.edu/

 

medicare.gov/dental-services

13 comments on “Dental under Medicare is very limited – 2022 Budget to increase benefits

  1. 9 comments on “Dental & Vision”

    1. give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare

      Adding dental, hearing and vision benefits to Medicare.

      Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,”

      Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

      https://www.fiercehealthcare.com/payer/framework-for-3-5t-senate-package-seeks-to-close-medicaid-gap-add-new-medicare-benefits-and

      Reply
    2. Anonymous says:

      What does Medicare A & B pay for vision?

      • Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.

        Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.

        Eye exams, if you have diabetes
        Glaucoma tests
        Macular degeneration tests and treatment https://www.medicare.gov/coverage/eye-exams-routine

        Does Medicare Part A cover any vision benefits?

        Not unless it’s a medical problem/emergency. Medicare Part A is intended to serve individuals strictly as a hospital insurance. If you are admitted to the hospital because of an accident involving your eyes, your plan benefits would apply; otherwise, you are responsible for all costs associated with routine vision corrections and eye exams. Oftentimes, individuals with Medicare Part A enroll in a private, individual vision insurance plan for coverage.

        Which vision benefits are available with my Medicare Part B plan?

        Medicare Part B is a medical insurance plan. As such, coverage applies to some vision care, but only when you have a medical condition that involves your eyes or affects your vision. Medicare Part B does not cover routine eye examinations and vision correction. That means prescription glasses and contact lenses will not be covered by your plan, unless you have had a necessary cataract surgery.

        Medicare Part B does cover annual glaucoma screenings for high-risk patients. These include individuals with diabetes or a family history of glaucoma, African-Americans over the age of 50, and Hispanics over the age of 65. Medicare Part B also covers cataract surgery, prosthetic eyes and special treatments for macular degeneration, but a 20% coinsurance cost typically applies to many of these treatments. https://www.vsp.com/eyewear-wellness/eye-on-vsp/medicare-vision-coverage

        See Medicare Benefits Booklet

        https://www.medicare.gov/coverage/eyeglasses-contact-lenses

        https://www.medicare.gov/coverage/eye-exams-for-diabetes

        Reply
    3. Anonymous says:

      Can you please send me Some info on a dental ins?

      Something comprehensive that takes care of root canals.

      And something where I can use the ins right away, if possible?

      Reply
    4. Dorothy A says:

      When can you sign up for the Dental plan?

      Do you need to wait until the general enrollment of insurance plans?

      Reply

      One can sign up for the 65 plus dental plan at any time of the year, per page 62 of the Blue Shield 2017 Confidential Agent Training.

      See above for the online link to enroll

      You might also want to check out Dental for Everyone http://www.dentalforeveryone.com/default.aspx?id=03355-00000 which also has year around enrollment.

      Reply
    5. Anonymous says:

      I live in Orange County California and have vision coverage under Blue Shield 65 plus.

      I cannot find a list of eye doctors that will take my insurance.

      Can you help me with that?

      Reply
      • We just updated this page to include the provider finder, above. Use the check box on type of doctor to put in Ophthalmology.

        We would be happy to be your broker of record. There is no charge. Blue Shield pays us to help you, when you appoint us. Here’s the form.

        Reply
  2. These Q & A’s are from a page that was outdated and we culled it.

    6 comments on “Dental – Optional Coverage”

    1. How do I go about finding a participating dentist and optometrist, for the Blue Cross add on to their Medicare Advantage Plan
    2. Steve,I am thinking of changing dentists. The last time I looked into dental insurance with my old dentist it really didn’t work out as she was pretty much a private pay dentist. (She did take delta dental but somehow I don’t think the numbers worked out at the time.)

      I am thinking of going to a dentist who takes most ppo plans. I am pretty sure I have no dental coverage at present. (I would appreciate your double checking on that since I just switched to medicare with a supplement and am not sure everything that is covered.)

      1. Is dental insurance a good deal for me? I.E.

      2. how much would it cost and how much would it save me?

      I would appreciate it if you could let me know my options.

      Thank you in advance for your time.

      Jim

  3. Thanks for the links to the various dental pages on your websites and Insurance Company quotes & brochures, however after reviewing even the most expensive one I have decided that all dental insurance is absolutely horrible and not worth a penny.

    I can’t believe this is not covered in Medicare

  4. I was at my daughters and playing with my 4 year old grandson when his head hit me in the mouth and knocked my front tooth out.

    Is this accident covered by Medicare or medi Cal?

    • I don’t see anywhere, where it seems to be covered under Medicare. Do you have a Medicare Advantage plan? Did you want to look into one? Try Checking with your dentist.

      Here’s our information on Medi-Cal Dental Medi-Cal dental benefits were fully restored in January 2018. If you have further questions on Medi-Cal Dental Benefits, please ask on that page.

      What county do you live in?
      What Medi-Cal Dental Program do you have? If you didn’t select a dental plan, you can probably do it now.

  5. I fell and hit my jaw. I went to the Dr. and x-rays and cat scan done. No broken bones. But I am having teeth pain that just comes and goes and pain in the joint of the jaw. If I go to a dentist or oral surgeon to determine if I did any damage to my teeth, is this covered?

    • Since it seems that your jaw wasn’t injured, my guess is no coverage. I simply reviewed the links above.

      Namely, it appears in your case Medicare only covers:

      Surgery to treat fractures of the jaw or face

      Which apparently you don’t have.

      I’m not a doctor, dentist or authorized Medicare employee. I suggest you check with your dentist.

    • I’m going to need more information as to why this was an “emergency.” Was this a

      temporomandibular-disorders/internal-temporomandibular-joint-derangement

      TMJ?

      Was there an accident?

      Trauma?

      Prior symptoms?

      Was this done in a hospital or dental office?

      What did your dentist say?

  6. Claims were submitted to BCBS of Florida who says we should have first submitted the claim to Medicare.
    What do you recommend?

    ****We’ve answered your question on this new page.

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