Medicare dental coverage is a government-run program that seeks to provide assistance to citizens 65 years of age and older in shouldering their expenses related to dental care. Medicare also extends the same generosity to those who have disabilities and those who are suffering from chronic kidney diseases.
However, in truth, Medicare’s dental benefits are actually more meager than generous, although in some very specific situations, having a Medicare coverage would be a great help. Generally, however, the list of benefits offered by Medicare is flanked on all sides by limitations.
Understanding the Limits and Benefits of Medicare Dental
1. Limitations of Medicare Coverage
Medicare dental coverage is fast turning out to be more limited than advantageous. Medicare can be very particular in terms of which dental procedures they include in their coverage. Surprisingly, Medicare does not provide coverage for routine and preventive dental procedures such as fillings and cleanings. What’s even more surprising is that they also do not cover the procedures that are most commonly demanded by citizens, namely extractions and dentures.
Aside from that, Medicare only shoulders, in the procedures they do cover, just the procedure itself, but will not pay for any material or dental device used to complete said treatment.
These limitations are all specified in the Social Security Act, stating that expenses pertaining to the care, treatment, filling, removal, or replacement of teeth or structure that holds the teeth in place are not covered. These structures that hold the teeth in place are referring to the gums and bones or tooth sockets. They are more specifically known as the periodontium, gingivae, periodontal membrane, alveolar bone, and cementum of the teeth. This means that periodontal procedures as well as surgical procedures such as dental implants are not included.
2. The Coverage Medicare Does Offer
So if all those are excluded from the coverage, what does Medicare have left to cover? According to the said Act, Medicare’s determination of excluded and included procedures are based on the type of service performed and the reason behind it. There are certain conditions that must be met before Medicare can step in to foot the bill.
Medicare willingly covers procedures that are necessary to repair the results of an injury as well as procedures that are done as part of a preparation for another treatment for a medical condition. Specific examples include extractions that are necessary prior to radiation treatments, as well as teeth and jaw reconstructions or ridge reconstructions following an injury caused by an accident or a tumor removal operation.
Also, if a dental procedure is conducted in conjunction with a medical treatment, such as oral exams conducted before a medical operation such as a heart valve replacement, a kidney transplant, or dental splints conducted with the treatment of dislocated joints, Medicare shoulders the costs.
In a modification of the initial program law, Medicare now also pays for hospital stays and in-patient hospital services related to dental care, as well as the dentist’s fee for the extended treatment, even if the procedure itself is not covered. The clause to include in-patient hospital services was added back in 1980, the last time that the rules stipulated in the Medicare dental program was modified.
3. Two Types of Medicare Insurance
For a more general perspective on the insurance offered by Medicare, we can take these benefits and group them into two main categories. Medicare offers coverage parts A and B. Part A is the coverage for all hospitalization services. Part B is the coverage for all doctor, surgeon, dentist, and other health professional fees.
These two types also do not come together. Part A is automatically granted to those who apply for Social Security. Part B, however, can only be selected as a supplemental coverage and comes with an extra charge in the form of monthly premiums.
Medicare Update – Medicare Advantage Private Fee-for-Service Plan
To respond to the changing and burgeoning needs of today in terms of dental care, Medicare has recently started offering dental coverage plans at very low costs to seniors who join state-regulated fee-for-service plans that are sanctioned by the Medicare. These plans usually provide both medical and dental assistance and work like the discount dental plans that are now widespread these days. Seniors who wish to avail of these updated benefits should still adhere to the same eligibility requirements of the original Medicare dental program.