Does Medicare Cover Dental?
Medicare Parts A and B, the original form of Medicare coverage, do not include traditional dental benefits like check-ups, cleanings, x-rays, and fillings. However, 71% of Medicare Advantage plans across the U.S. offer some form of dental benefits. Since dental benefits differ among Medicare Advantage insurance plans, it’s important to compare dental benefits alongside their monthly premiums (which in some cases may be as low as $0 per month given government reimbursement rates for Medicare Advantage plans).
Given this situation, the answer to the question “Does Medicare cover dental services?” is “no” for original Medicare but “yes” in many cases for government- subsidized Medicare Advantage plans. In contrast, Medicare Supplement plans (also known as Medigap plans) normally do not provide dental benefits.
Why Is Dental Coverage So Important for Seniors?
While a small percentage of older adults have dental insurance, it is extremely important. Aside from leaving cavities untreated, inadequate dental insurance may lead to poor oral health that, in turn, can lead to grave overall health consequences. Among these potential consequences are nutritional problems, respiratory infections, and increased risk for heart disease and stroke.
Seniors often lack dental insurance because they traditionally received dental insurance through an employer or union and, after retirement, these benefits were no longer available. Original Medicare Part A and Part B do not cover basic dental services. Medicare will only cover dental services where these services are an essential component of a covered medical procedure (e.g. wiring of a jaw to stabilize it after a jaw fracture has occurred).
As we age, we have a higher probability of using prescription medications. Consequently, seniors are more likely to use prescription drugs than in their twenties. Sometimes one or more medications will result in “dry mouth.” Dry mouth is when the mouth produces an insufficient level of saliva. The lower supply of saliva increases bacteria in the mouth and the risks of tooth decay and gum disease, both of which can be costly to treat. Several hundred medications may have dry mouth as a side effect. Not surprisingly, three out of ten seniors experience dry mouth. Seniors can help reduce the negative effects of dry mouth by:
- Frequently drinking water throughout the day
- Avoid contributors to dry mouth such as caffeinated beverages
- Chew sugar-free gum (this will promote saliva production)
Dentures can be a costly investment for those living on a fixed income. The cost of dentures may be $300 to $4,000 per plate, depending on the extensiveness of the denture and its quality. A denture plate is a removal dental apparatus that replaces teeth and gum tissue. A complete denture plate replaces all teeth in the upper jaw or lower jaw. A partial plate replaces some teeth within either jaw. Consequently, if a senior needs both upper and lower plates than the estimate price may be in the range of $600 to $8,000 or more. Original Medicare Parts A and B never cover dentures. In some states and under some conditions, Medicaid (the state-run health program for groups of low income people, include some dental coverage. Given the high costs of dentures, many seniors are incented to comparison shop costs among dentists in order to find affordable dentures.
Dentures must be personalized to the person using them. Measurements and casts are required in order to obtain a proper fit of the new dentures. This can mean the need for multiple dentist visits to complete the denture process. Additionally, tooth extractions may be necessary and these extractions could cost several hundred dollars per tooth.
There are several types of dentures. “Conventional dentures” are made for use in the mouth eight to twelve weeks after teeth have been extracted and the surrounding tissue has healed. In contrast, “immediate dentures” are fitted and made prior to a tooth extraction and be worn in the mouth during the healing period.
Seniors should be aware that there are options other than removable dentures to address missing teeth. Dental implants can replace teeth as well as a fixed bridge. Before committing to a particular procedure, a senior should discuss all the options with a dental professional.
Medicare Dental Plans
As indicated earlier, the government’s original Medicare program does not offer a Medicare dental plan. However, a Medicare beneficiary can potentially receive dental benefits through a Medicare Advantage plan or a stand-alone dental plan sold by an insurance company. Before purchasing dental coverage, a consumer should confirm:
- Does my dentist or dental professional accept this insurance?
- What dental benefits (e.g. bi-annual cleanings, x-rays, fillings, crowns, etc.) are included within the insurance coverage and do those benefits align with my needs?
- Are there any limitations on the dental benefits (e.g. an annual cap on insurer payments)?
What to Do Given the Absence of Medicare Dental Coverage
For seniors who do not have dental benefits through a Medicare Advantage plan, retiree health plan, or stand-alone dental insurance plan, there are several additional options that may help to reduce dental costs:
- Seek preventive dental care (e.g. bi-annual teeth cleanings) and don’t let known dental problems persist. The longer you wait to address an issue, the more expensive it can become
- Contact The Dental Lifeline Network to see if there is a program that can assist you in your area
- Check for local dental schools that may offer reduced rate dental care
- Avoid smoking
Finally, a last, and rather obvious recommendation is to brush multiple times per day with fluoride toothpaste, floss, and avoid sugary foods that contribute to tooth decay.
Which dentists accept a Medicare plan’s insurance coverage depends on the plan’s provider network. A provider network is a collection of healthcare professionals (such as doctors, nurses, and dentists) who have contracted with an insurance plan and agreed to accept its reimbursement rate for medical services. Dentists outside of a plan’s provider network are not obligated to accept the insurance plan’s coverage for dental services and procedures. Remember, if you have more significant dental issues you may need to confirm not only a particular dentist’s participation in a health plan network but also the participation of your oral surgeon, periodontist, or orthodontist.