Medicare & Dental Benefits
Many people don't realize that Medicare covers some dental procedures; however, the coverage is very limited. Of course, Medicare does not cover regular preventative treatments, but the program does pay for costs of other in-depth procedures that are related to a medical condition and result in hospitalization. As a general rule, though, you will probably have to pay 100 percent for your regular dental procedures.
The Statutory Dental Exclusion
The Statutory Dental Exclusion basically says that Medicare does not cover any routine dental exam or procedure such as cleanings, fillings, tooth extractions or dentures. However, it will pay for hospitalization related to a dental emergency.
Background
The website for the Centers for Medicare and Medicaid Services reports that the Statutory Dental Exclusion has not been amended since 1980, when it made the exception for inpatient hospital services when the dental procedure made hospitalization necessary.
Difference Between A and B Coverage
Medicare A is the main plan that all people get when enrolling in the Medicare program. Part A covers hospital stays, nursing home stays, home health and hospice. Part B is an optional plan that covers medically necessary procedures. Even though the plan is optional, many people choose to take it. Part B covers doctor visits, outpatient visits, therapy services and additional home health services. In general, each covered dental procedure performed by a dentist will be paid by Medicare Part A. If a physician performs the service, it will be paid by Medicare Part B.
What's Covered
The website for The Centers for Medicare and Medicaid Services reports that coverage for dental procedures is determined by the type of service that is provided and the body part involved. It is not determined by the cost of the services provided. The types of services covered are services that are an essential part of a covered procedure or for extractions that are done in preparation for radiation treatment due to diseases involving the jaw. Other procedures, such as reconstruction of a jaw after an accident, may also be covered. Medicare also pays for oral examinations (but not treatment) due to a kidney transplantation or heart valve replacement, but the determination will be left up to Medicare.
What's Not Covered
Certain services are excluded under Medicare Part B (which is the plan that pays for medically necessary procedures). These services include primary services (no matter how complex) provided for the care, treatment, removal or replacement of teeth or structures directly supporting teeth. For example, for people needing dentures due to diseased teeth or infection, Medicare will not pay for services involving the removal of teeth. The other types of services that are excluded are secondary services related to teeth or structures directly supporting the teeth unless it involves treatment for a medically related condition such as a tumor removal. This service must be performed at that same time the primary services were done and by the same physician and/or dentist. Also, Medicare will not cover the cost of dental appliances such as dentures or implants even if they are necessary due to the medical condition that required the extractions.
Tags: Dental Exclusion, dental procedures, Medicare Part, plan that, Statutory Dental
