Dental Services That are Covered by Medicare

January 10, 2022

  

Dental Services that are covered by Medicare include preventive services, diagnostic services, emergency services, endodontic (root canal) care, and other necessary dental treatments. The coverage is limited to certain low-income individuals who meet the income and resource requirements specified by the Medicare program. Let's explore the services covered by Medicare and what that implies.

1. Preventive and Diagnostic Services

This is a range of basic dental care, such as cleaning and X-rays, that help prevent problems such as tooth decay and oral cancer. Dental cleanings for people with Medicare are covered every six months. Diagnostic services include dental tests that help your dentist discover cavities before they become painful and more extensive work such as root canals and oral surgery. You can get more information from Medicare Help AZ on this. These two services also include fluoride treatments and sealants, which can help prevent tooth decay. Some preventive and diagnostic services may require prior authorization from Medicare to be covered. This includes such things as teeth bleaching, fillings of large cavities, crowns on teeth, etc. These items would fall under the category of "Extensive Preventive Measures," the cost of which is not usually reimbursed by Medicare.

2. Emergency Treatment

Emergency dental care is a basic service included in most health plans, including Medicare Advantage plans and Managed Medicaid plans. If you have a toothache or have lost a tooth due to an injury or accident, your dentist should accept emergency appointments even though they will be out of network for you. Limited emergency dental service is covered if an unexpected, serious problem happens during the normal working hours of 7:00 am to 7:00 pm Monday through Friday or 8:00 am to 5:00 pm on Saturday. If you have life-threatening symptoms such as pain or swelling, call 911 or go directly to the emergency room.

3. Endodontic (Root Canal) Care

Root canals are one of the most common dental treatments, especially for older adults who experience more wear and tear on their teeth over time. A root canal is a necessary treatment when the inner pulp of a tooth becomes infected or inflamed due to decay or trauma to the tooth. The dentist removes the diseased pulp from inside the tooth before sealing off and "capping" it with a crown or filling it with another material. Unfortunately, Medicare does not consider endodontic care as reimbursable dental treatment, even though approximately 12 million root canals are performed in this country every year. Fortunately, there are many affordable options for financing root canal procedures if you need one.

4. Other Necessary Dental Treatments

Other necessary dental treatments include procedures such as placement of braces, removal of teeth or cysts, surgical treatment of gum disease, and oral surgery for cancer patients. In some cases, these services may require prior authorization from Medicare to be reimbursed by Medicare. If your dentist believes any of them are necessary, they can submit a claim for review on your behalf. You should also ask whether the service is considered routine under Medicare guidelines before consenting to it.

5. Restorative Procedures Covered by Medicare

If you have missing teeth due to decay or injury that cannot be restored with a filling alone, dentures or dentures may be covered by Medicare. Other restorative procedures such as bridges and crowns may be covered if they are medically necessary and not merely for aesthetic purposes. Be aware that there is usually a low cap on the number of dental implants Medicare will cover per year, usually no more than nine or 10 replacements over your lifetime. Medicare does not typically cover veneers, clear plastic shells placed over teeth to change their color or shape unless they are used to correct pain from exposed roots or other medical issues.

6. Orthodontic and Prosthodontic Services

Orthodontic services most commonly include braces and retainers to straighten crooked teeth and close spaces between them. While orthodontic services themselves can be extremely expensive without insurance, many providers offer discounted rates for people under age 21 or in special circumstances. If you are paying for braces yourself, make sure to ask your dentist about financial assistance opportunities if they are available. Prosthodontic services include replacement of missing teeth with dental implants, fixed bridges (non-removable), and removable dentures. Medicare does not cover routine maintenance or repair of removable prosthetic devices such as dentures. However, it may pay for the replacement of these items if the patient's natural teeth have been lost due to injury or illness and cannot be restored with other methods.

Medicare does cover a variety of dental services. However, it only covers the most basic and critical procedures. Keep in mind that some providers offer discounts or payment plans for patients who pay out of pocket for their care but do not have insurance coverage through another plan. Make sure to discuss your situation with your local dentist to find out what types of services you can anticipate being covered.

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