dental care

Medicare Dental Coverage
The Dental Benefits and the Limitations

Medicare dental benefits are free dental benefits offered by the government to senior citizens past the age of 65, as well as to those who suffer from kidney diseases and physical disabilities. The aim of Medicare is to help them pay for their dental health care needs.

The problem is, Medicare members easily get disillusioned about the dental benefits offered by the said program once they get acquainted with the coverage it promises.

A Medicare beneficiary soon finds out that Medicare only covers a very limited aspect of dental costs.

So it helps if, before you seek dental care, you already know what exactly Medicare covers so you won’t be suddenly faced with bills you can’t pay and you can find another financing aid if your dental costs do not qualify for Medicare coverage.

The Scope of Medicare for Teeth

  • What is included
  • What is not included

1. What is included

medicare dentalMedicare dental coverage is very limited, as many beneficiaries have found out too late.

So if you find out you are entitled to Medicare, don’t celebrate just yet. Take time to find out what the coverage really means, so you won’t find yourself faced with bills you thought would be covered.

Medicare only pays for the costs of dental procedures if the dental problem being fixed is caused by an injury or if the dental procedure is necessary so that another medical treatment necessary to treat an underlying medical condition.

That sounds confusing enough. As an example, Medicare will not provide coverage for a typical tooth extraction done because the tooth was damaged by tooth decay, but it will cover tooth extractions if the tooth is damaged by an injury or if the extraction of tooth is necessary for, for example, a radiation treatment.

Medicare will also cover oral exams that are conducted as part of the preparations for a heart valve replacement, dental splints, kidney transplants, and so on.

Medicare also pays for hospitalizations that become necessary if an ongoing dental treatment has placed the patient in a severe condition. Medicare will also pay for the fee the dentist charges for the extension of the treatment. However, Medicare will not pay for the actual procedure. The hospitalization coverage was a revision made to the plan in the eighties.

2. What is not included

Although you are already given an idea as to what Medicare does not pay for, it is better to be more specific about this to make sure you don’t get misled.

Medicare dental benefits do not apply to routine and preventive dental procedures, minor dental procedures, nor major dental procedures. Cleanings, sealants, fillings, fluoride, checkups, extractions, root canals, dental implants, dentures, crowns, bridges – not a single one of these are covered on their own, if the conditions stated above are not present.

Also, if the above stated conditions are present and the procedure is then covered, Medicare will only pay for the procedure, but not for the materials that are involved in the procedure.

And since Medicare also makes it clear that it will not pay for procedures that treat the teeth and the structures around it, this means even periodontal procedures, which treat the gums, are not covered as well. This exclusion is the most well-known aspect of Medicare.

The laws of Medicare have been in place for years and years, and it was modified the last time in 1980. Thus, previous limited coverage laws still apply today.

Three Important Aspects

Medicare’s benefits can be grouped into three types: Part A, Part B, and a special fee-for-service plan. Parts A and B make up the overall clauses of inclusions and exclusions of Medicare.

In Part A, Medicare promises to cover hospitalization services related to dental care.

In Part B, Medicare promises to pay for the professional fees to be paid to doctors or dentists. These two parts make up the overall coverage offered by Medicare.

The third aspect of Medicare dental benefits is the fee-for-service plan offered by Medicare. These are special plans that can be availed of by senior citizens who want more than the regular coverage offered by Medicare.

The fee-for-service plan can help you pay for the costs of regular dental procedures that the typical Medicare coverage does not offer. These plans, however, are not free.

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