Medicare in the USA has been in place for a number of years now and is a Government program that covers the cost of some of the healthcare for those that are eligible to join. This typically includes individuals aged 65 and over, a number of disabled people that are under the age of 65 and individuals of any age that have been diagnosed with end-stage kidney disease. There are a number of medical procedures that are included as part of the Medicare program. Medicare dental coverage is one of these, although this is typically very limited in what costs will be covered.
History of Medicare dental coverage
When Medicare first came into being, dental care was not covered as part of the program. Little has changed since this time and Section 1862 (a) (12) of the Social Security Act excludes the vast majority of dental work from the main parts of Medicare which are Parts A and B. General dental care for the teeth and underlying structures holding them in place is typically not included and this includes procedures such as removals, replacements and filling of teeth. Being fitted with devices such as dental plates and dentures is also not included. Typically these types of dental treatments will not be paid for under Medicare Parts A and B coverage. However, there are some circumstances where the cost of dental work will be covered.
Costs covered by Medicare dental coverage
There are situations where the cost of dental work will be included as part of Medicare Parts A and B coverage. Examples of this include where dental services are required as part of a procedure that is covered by Medicare. This can include removal of teeth carried out as a result of a jaw disease not directly related to the teeth, or mouth examinations not specifically carried out for the care of the teeth, but to identify existing medical problems prior to undergoing surgery for procedures such as kidney transplant. Other costs covered can include where hospitalization is required for emergency dental procedures, with the cost of the hospital being paid, although the cost of the dental work itself may be excluded. In general if dental work is specifically required for the routine care of the teeth and the structures supporting the teeth, Medicare Parts A and B will likely not cover the cost. However if dental work is indirectly required as a result of another procedure that is covered by Medicare Parts A and B, the cost of the dental treatment needed should also be paid for.
Medicare Advantage Plan
Since there are gaps in the medical procedures covered by Medicare Parts A and B, approved insurance companies can provide plans that essentially plug these gaps. Medicare Part C is typically known as the Medicare Advantage Plan and those that are eligible can choose this as their option for receiving Medicare. This option can include dental coverage, although a monthly premium is typically required to obtain this. The premiums paid can be influenced by a few factors such as the services included, where you live and the deductibles and copayments selected. However, for those eligible for Medicare that want the security of having dental coverage that will cover the cost of routine treatment, a Medicare Advantage Plan is an option to consider. The companies that provide these will typically vary from state to state although some of those that do have these available include Aetna, Humana, and AZMedicare.
Looking after the health of your teeth is important at any stage of life and this is as true for seniors as it is for anyone. For those that are 65 years of age or older Medicare dental coverage can pay for some of the costs of dentist treatment. However this tends to be limited where Medicare Parts A and B are concerned and will typically only apply in indirect cases where the dental treatment is required as part of a medical procedure that is covered. For those that want coverage for the routine care of their teeth, Medicare Part C (Medicare Advantage Plan) is an option to consider. However, there will typically be a cost involved in obtaining dental coverage for routine treatment and it needs to be considered at the time of deciding which Medicare Plan to opt for.