An important factor in maintaining physical health is dental care. The question most Medicare recipients ask is this: "Does my Medicare cover dental?" The short answer to this question is that Medicare does not cover routine dental care. This means that Medicare will not pay to have your teeth cleaned. They will not pay for your X-rays, extractions, fillings, bridges, implants, route canals or even dentures. However, the long answer to this question is that Medicare will pay for dental care if it is deemed medically necessary.
What does "medically necessary" mean?
Medically necessary means that if you have a medical condition that merits you receiving a root canal, dentures or other dental care that is typically routine, then Medicare will cover it. For example, if you have oral cancer and because of that cancer you need to have a tooth extracted, Medicare will cover the cost of that tooth extraction because it is linked to the care of your oral cancer. The same is true for any other routine dental care services. If the dental care service can be linked to another medical problem and must be completed to help treat that other medical problem, then Medicare will cover it.
What non-medically necessary dental care?
For dental care that is not medically necessary, there are other options that may help you obtain the dental care that you need or want. Medicare Advantage Plans, stand-alone dental insurance, private pay and even Medicaid programs can assist with your dental care bills.
Medicare Advantage Plans
Medicare Advantage Plans are insurance plans that can be purchased to supplement your current Medicare coverage. These Medicare Advantage Plans provide benefits that are not covered by Medicare and can be helpful in obtaining dental coverage as well as other routine coverage. There are several Medicare Advantage Plans available, and each offers its own benefit package.
The downside to Medicare Advantage Plans is that they may not have a large network of dentists. This means that you may have to see a new dentist. However, the best rule of thumb is to find the plan with the dental benefits that fit your needs, despite having to possibly find another provider. Another issue with Medicare Advantage Plans is that the benefits may change each year, and you will have to renew the plan every year.
Stand-alone dental insurance
Stand-alone dental insurance is provided by a reputable dental insurance provider that is separate from Medicare. The benefit to this type of plan is that the dental coverage can be very expansive and may include all of the routine dental services that you will need. They also include major dental services such as bridges, crowns, root canals, and dentures.
Additionally, the benefits do not change, and you do not have to renew the plan each year. You can also add family members who reside with you to a stand-alone dental insurance plan. Some of these plans do have a set network of providers that you must use, while others do not. So depending upon the plan that you choose, you may be able to keep your current dentist.
Private pay
Private pay dental care services are just what they sound like: You pay for all of your dental care out of pocket. You are responsible for all of the costs for all services. It is possible to find dentists who allow private pay patients to provide payment on a sliding scale, meaning that your income is taken into consideration when they charge you for services. Also, there are certain dentists who have financing options for private pay patients. Some of these financing options allow you to pay no interest for up to a year if all of the payments are made on time each month.
Medicare dental services
While Medicare does not offer a lot of dental services, it does offer some routine dental services and some major dental services without payment. However, you must qualify for Medicaid to be able to take advantage of Medicaid dental services. Medicaid requires that you are low income and have a disability in order to qualify. Each state has a different Medicaid requirement in order to obtain Medicaid benefits. However, if approved, Medicaid does provide X-rays, cleanings, some extractions and a one-time benefit of dentures in most areas. Some states offer more dental benefits than others. If you qualify for Medicaid in your state, you can find the dental benefits at the time that you qualify.
Unfortunately, if you are a Medicare recipient, you are not offered many paid routine dental services. However, there are many options to assist you in obtaining additional dental coverage that are not provided by your Medicare coverage. It is best to understand your options and choose the plan or alternative that fits your dental needs.