Medicare Dental Coverage

If you are under 21 years of age, Medicaid and Medicare cover a comprehensive set of dental services as part of its overall health support plan. Dental services for children are provided at the reasonable standards of dental practice, which simply means most states will reimburse services once per year. (Each state’s rules vary.)

Under the rules of most states, Medicaid acts like a discount dental insurance for children under the age of 21. Participating dentists charge reduced fees for their services and decide if the family must pay part of the bill after the Medicaid payment has been subtracted. The bill is usually determined by a sliding scale fee, so the family may or may not have to pay for part of the service.

Federally-mandated Medicare dental coverage does not exist, although some states provide at least emergency dental care coverage for Medicaid-eligible people over the age of 21.

Medicare is a physical health program for seniors, the disabled, and the economically challenged who cannot afford other health insurance. Medicare excludes paying for dental treatments for the most part.

According to the United States Department of Health and Human Services, Medicare will pay for dental services only if they are part of other covered procedures. For instance, Medicare will pay for dental services if they are part of reconstructing the jaw after an accident, or if teeth are extracted in preparation for radiation treatments.

Medicare dental coverage also includes dental examinations preceding such major operations as kidney transplant or heart valve replacement, as long as the exam is in preparation for the other surgery and is performed by a dentist on staff at the hospital.

Also excluded are primary services for the care, treatment, removal, or replacement of teeth and tooth structures. Medicare will not pay to prepare your mouth or dentures, or for the removal of diseased teeth in an infected jaw.

Secondary services such as dental appliances, dentures, or repairing damaged teeth are not covered by Medicare dental coverage. Even if another procedure made it necessary to extract your teeth, Medicare does not reimburse the cost of fixing the missing teeth.

Since the United States Congress has not amended the Medicare dental coverage rules and exclusions since the early 1980s, it is very important that adults supplement their Medicare insurance with additional dental insurance coverage. Dental insurance for an entire family costs a few dollars a month and can save the family hundreds, if not thousands, of dollars in dental care costs.

Research carefully and ask your all care dental plan provider if they have a special plan for Medicare recipients. Some dental insurance companies offer reduced premium or sliding scale plans for Medicare recipients. This makes supplemental dental insurance incredibly affordable.

Lobbyists from dental professional groups, dental insurance providers, and the American Dental Association are working hard in Washington, D.C. to get the Medicare rules changed. The new Congress and administration have a lot of work ahead of them to solve our nation’s healthcare crisis, and dental benefits are an important component in the big picture.