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 hospital. medicare.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 ⇒
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?
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 Budget – Improving 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].
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…
- Medicare Advantage Plans – Part C
References & Links
- Justice in Aging - Webinar Oral Health Coverage for Low Income Seniors
- 4 page summary of Denti Cal benefits from Justice in Aging
- National Institute for Dental Research - Caregiver information
- Health.Gov tips for older adults
- One of our colleagues on how Dental for Everyone Works.
- Sample Quote
- Blue Cross Dental & Vision
- Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental
- Blue Shield Medicare Advantage Dental & Vision
#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 ⇒
- anthem.com clinical guidelines
- Our webpage on Medical Necessity
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/
See also our pages on dental for under 65
- Child Dental & Vision
- Covered CA & More
- FAQ’s – Explanations – Technical Info
Website Video #Introduction
- 17 Reasons to use Steve Shorr Insurance
- Set a Meeting
Our Webpage on Insurance Coverage for
Be sure to put in our AGENT # 2094784
Delta Dental – Covered CA Plans
- Delta Dental Individual & FamilyTM Delta Dental PPOTM Family Dental Plan 669 KB
- Delta Dental PPOTM Children’s Dental PPO for Small Businesses 790 KB
- Delta Dental PPOTM Family Dental PPO for Small Businesses 794 KB
- Delta Dental Individual & FamilyTM DeltaCare® USA Family Dental HMO 872 KB
- DeltaCare® USA Children’s Dental HMO for Small Businesses 837 KB
- DeltaCare® USA Family Dental HMO for Small Businesses 848 KB
Careington Discount Dental Plan
Careington Discount Dental and Vision Plan with EyeMed Vision
Careington Maximum Access Discount Dental Plan
Careington Maximum Access Discount Dental & Vision Plan with EyeMed Vision
Dentaflex Advantage Plus PPO
Max Essentials PPO
Dental for Everyone Gold Plan Delta Dental PPO
Dental for Everyone Gold Plan Delta Dental Premier
Dentaflex Select PLUS 1500
Dental for Everyone Platinum Plan Delta Dental PPO
Dental for Everyone The No Wait Plan Delta Dental PPO
Dentaflex Select PLUS 2000
Dental for Everyone Diamond Plan Delta Dental PPO
MAX Choice Plan PPO/MAC
Dental for Everyone Platinum Plan Delta Dental Premier
Dentaflex Classic 1500 Plan
Dentaflex Classic 1500 Plan
Dentaflex Classic 2000 Plan
Dentaflex Classic 2000 Plan
Dental for Everyone Diamond Plan Delta Dental Premier
Dental for Everyone Immediate Coverage Plan Delta Dental PPO/Premier
MAX Choice Plus Plan PPO
Child & Related Pages – Site Map