The answer to the question “Does Medicare cover dental?” is both direct and complicated. In short, you should expect to pay for 100% of the dental services you receive. Medicare does not cover any routine dental procedures like fillings, extractions, cleanings, checkups or dentures.
The complicating factor lies in a section of the Social Security Act which allows Medicare to pay for services related to the periodontium (gums) and alveolar bone structures (tooth sockets). The type of service provided and which physical structures are involved will be the qualifying items to determine whether Medicare will cover all or part of those expenses. It is not related to the merits of dental care nor to the necessity of the procedures. While this may cause some confusion, it is clear that your every day dentist appointment for routine or preventive dental care is not covered by Medicare.
Some of the treatments that Medicare will cover include:
- Some surgical procedures to reconstruct a ridge at the same time as removing a tumor.
- Wiring the teeth if it is part of repairing a jaw fracture.
- Tooth extractions that are done to prepare for radiation treatments involving the jaw.
- Hospital stays may be covered if they are necessary for emergency dental procedures, even if the specific dental care is not covered.
- Most dental treatments that are essential to a procedure that is covered, such as reconstructing the jaw after an injury.
- Dental splints can be covered if they are part of treating a medical condition that is covered, such as dislocated jaw joints.
- Under specific circumstances, examinations which precede major surgery such as heart valve replacement or kidney transplants. The exam, but not the treatment, is covered because the examination is expected to identify increased infection or risks prior to the complex surgery.
- Inpatient hospital services if the severity of the dental treatment requires hospitalization. But it does not pay for the dental care itself.
- Infections which follow tooth extractions may be covered.
- Inpatient hospital care if you require observation because of a health threatening condition.
It does not matter whether a dental procedure is done at the dentist’s office or in the hospital. If a dental procedure is covered, Medicare covers the care regardless of where it is performed.
Some dental procedures are covered by private supplemental Medicare insurance. In these situations, you certainly need to confer with your insurance provider to clarify the coverage. Often the specific treatment, like tooth extraction, may be covered but the dentures or follow-up care will be excluded.
A brief answer will tell you that dental services may be covered if they are necessary to protect your overall health. But your dental health is not specifically covered by Medicare.