What Dental Services are not covered by Medicare?

Medicare pays for dental coverage only when dental care is related to another medical illness or problem. Almost nothing related to routine dental care is covered under Original Medicare.

For example office visits and dental checkups are not covered under Medicare. Neither are dental x-rays, fillings, root canals, crowns, extractions or dentures. Medicare seems to have a real phobia of dentures and they will never be covered under any circumstances if you have Original Medicare. In certain cases where a tooth infection requires an extraction before a major surgery Medicare will pay to have the tooth removed. However, they will not pay for dentures or bridgework to fill the missing gap. The patient is responsible for 100% of the cost of these services.

Sometimes dental work requires hospitalization. This may be necessary for periodontal surgery, major extractions or for other reasons related to the patient's health. When this is the case and the patient has Original Medicare, Part A will usually pay for the hospital stay and fees related to hospitalization. However, Part B will not cover the cost of the dentist or anything that is directly related to the dental procedure. If hospitalization is needed make sure to carefully check with Medicare and your dentist before the procedure so that you know what will and will not be covered. Medicare rules related to dental procedures are very strict. Moreover, any dental procedure that requires hospitalization should be necessary for your continued health and well being. It is always advisable to also consult your regular doctor in such cases.

Dental Coverage Under Medicare Advantage Plans

Dental coverage is available under some Medicare Advantage Part C Plans. These plans let Medicare recipients have access to the types of dental coverage that they offer through their standard insurance plans. If the insurance you had while you were working offers a Medicare Advantage Plan you may be able to keep the same dentist as long as he or she is on the preferred provider list of the Medicare Advantage Plan.

Dental Coverage Under Medicaid

Ironically enough Medicaid not only offers dental services, dental is mandatory for all Medicaid eligible individuals under the age of 21. This is part of the Early and Periodic Screening, Diagnostic and Treatment benefit. Known as EPSDT this program is required by state Medicaid programs. The idea behind EPSDT is that early diagnosis and treatment is cheaper and more effective than waiting until problems become large and expensive. If you are eligible for both Medicare and Medicaid check with your state to see if your state's Medicaid coverage includes dental care.