Medicare does not cover most dental care, as well as dental procedures, supplies, routine annual cleanings, fillings, tooth extractions, dental plates, dentures, or other types of dental devices.
However, Medicare Part A (Hospital Insurance) will pay for certain types of dental services that a Medicare enrollee receives when he or she is in the hospital. In addition, Medicare Part A may also pay for inpatient care if an enrollee needs to have emergency or complicated dental procedures performed – even if the actual dental care is not covered.
The only type of dental care that Original Medicare (Medicare Parts A and B) will pay for at all is dental services that are considered to be an integral part of either a covered procedure (i.e., reconstruction of the jaw following an accidental injury), or for extractions that are done in preparation for radiation treatment for neoplastic diseases that involve the jaw.
In addition, Medicare may also cover oral exams, but not treatment, proceeding either a kidney transplant or a heart valve replacement – but only under certain circumstances. This would be covered under Medicare Part A (Hospital Insurance) if it was performed by a dentist who was on the hospital’s staff, or under Medicare Part B (Medical Insurance) if the procedure was performed by a physician.
In order to determine how much your service may cost, you should discuss the situation with your doctor or other health care provider. This is because the cost can be dependent upon a number of different factors, including any other insurance coverage that you may have, the amount that your doctor charges, whether or not your doctor accepts Medicare assignment, the type of facility where you obtain your services, and the location where your get your service.
Although Medicare Part A and Part B only cover very limited dental related services, there is an alternate option for enrollees to obtain dental services – including dentures – through Medicare. This is by purchasing a Medicare Advantage plan.
Medicare Advantage – also referred to as Medicare Part C – is an alternative method of receiving all of one’s Medicare Part A and Part B coverage. In addition to all of Part A and B benefits, additional coverage may be provided, including items such as vision and dental services.
There are many Medicare Advantage plans that provide either full or limited coverage for dental cleanings, x-rays, oral hygiene consultation, crowns, root canals, oral surgery, and / or dentures.
Medicare Advantage plans are offered by private insurance companies and not directly via Medicare. Therefore, various out-of-pocket costs such as deductibles and / or co-payment amounts may apply, depending on the particular plan that is chosen. It may also be required to see health care providers that are located within a specific provider network.
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