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Dental Coverage Under Medicare General Information Guidelines & FAQs Updated March 2018

Medicare considers dental services as an important part of citizens overall health and wellness. This is why it gives priority in making sure that people are given proper care and treatment when it comes to their dental needs.

The Medicare General Information Guidelines & FAQs Updated June 2015 gives emphasis and has improved dental benefits and coverage. Dental coverage with Medicare is something that you must take a careful look at because it is a little bit different from medical coverage. The majority of people will look at dental coverage as some other policy entirely, but that is not the case. You should look at the updated Medicare dental coverage guidelines, and you must contact the service center when you have questions about where you can go, what you can do, and how you will stay healthy.

Background of Medicare Dental CoverageImage result for Medicare Dental Coverage illustration

The dental treatment has been included as a part of the initial Medicare since the inception of the healthcare program. In including dental benefits, but Congress did not put any limitations for the dental services – compared to other health care services such as foot care. Instead, the Law Makers widen the coverage as much as possible to ensure a healthy dental for all eligible members and individuals.

Medicare Dental Coverage

Dental care is one of the Medicare services with the widest coverage. It covers even the most complicated procedures including jaw reconstruction after an accident. Complex procedures also include radiation treatment for neoplastic diseases that often involves the jaw. Medicare will answer to some dental services if it has been proven that they are needed for the protection of your overall health condition.

What Medicare Will Pay For?

  • Medicare will pay for your dental expenses if you will undergo kidney transplant or a heart valve replacement and you need your teeth in good condition prior to the transplant.
  • It will cover your dental fees if you are suffering from a disease that involves the jaw, such as oral cancer and you need dental services for the radiation treatment.
  • It will also cover the expenses for dental if you need tumor removed from your face and it involves jaw reconstruction and if you need dental splints that occurred after a jaw surgery.

Another coverage for dental care is the payment for oral examinations. However, the treatment will not be covered previous to a kidney transplant or heart valve replacement, under certain circumstances. Every member should know that dental coverage is not determined by the value or the necessity of the dental care that needs to be done but by the type of service provided. It is also based on the anatomical structure that needs to be performed for the member.

What Does Medicare Not Cover?

  • Follow-up dental care after the primary health condition has been treated.
  • Payment for dentures
  • Dental supplies, like cleanings and fillings
  • Tooth Extractions
  • Dental plates

Why Is Dental Coverage With Medicare Different? Image result for Dental Coverage With Medicare

Dental coverage with Medicare is different because dentists are often housed under their own insurance. They are handled by the same insurance plan that would help you go to the hospital. You are given completely different parameters, and dentists are free to choose which panels they want to be on. Because of this, you must see the dental coverage manual so that you know what you get when going to the dentist. Dental appointments and general practice appointments are not the same.

Call The Service Center 

A service center is a place that you can call at just about any time to learn about your dental coverage. You could call to ask questions about which dentist you can visit, and you might ask the service center if they have recommendations for dentists who are in your area. The service center can explain your coverage, and they can help with special dental procedures that you might have concerns about.

Semi-Annual Appointments 

You can make your semi-annual appointments with the service center or your dentist’s office. You are allowed these two checkups because that is what is recommended by the dental establishment. This is no different from any other plan, and you might pay a small copay when you go to the office. Medicare, however, typically does not require a copay unless you have an advanced procedure.

Cavities 

Cavities are covered under the Medicare plan because they are seen as routine follow-ups. You can schedule your appointments for fillings at the same time you have your routine appointment, and Medicare will cover these completely. You might have cavities at both appointments during the year, but you are allowed fillings after each appointment. Medicare knows that this is common, and your dentist can schedule you for covered appointments in both instances.

Special Procedures 

Special procedures are covered under Medicare if you have a need that is confirmed by your dentist. Your dentist might recommend a procedure, but they often need a dental surgeon to do the work. You could call the service center to ask for an appointment with a dental surgeon, or you could ask for places to contact in the area. You might have questions about how much is covered, and you will find that some procedures are covered more than others. You can make financial decisions at this point that will help you either save money or plan to pay for the treatment.

Emergencies

Emergencies are out of your hands, and you must do something to help repair your teeth or stop you from suffering such great pain. You can go to an emergency clinic at any time, and they will help you just as your traditional dentist would. You might want to call your dentist if they have an after-hours service, and you could pretty easily get your tooth repaired even in the middle of the night. Medicare covers most of these procedures, and you could check with the service center if you have questions.

Supplemental Insurance Image result for Supplemental Insurance 

Supplemental insurance will help cover the gaps in your Medicare, and these insurance plans will pay for dental procedures that are not covered under your standard plan. You might want to use the supplemental insurance for your health coverage at the same time, and you will find that you could easily have the supplemental plan pay for everything that was not covered in the first place.

How Is Medicare Paid For?

Medicare has been paid for by the government, and all claims are handled by the dentist. They will let you know if anything is not covered, and they will use your supplemental insurance where needed. You simply must have your insurance card ready when your appointment comes around. The office needs to check your coverage so that they know you can have your appointment at that time, that you are eligible for extra care, or that you are eligible for the special procedure scheduled for that day. Medicare handles itself internally, and you will rarely receive a bill for the responsibility you must take on after everything is paid.

How Do You Verify Coverage? 

You could ask your dentist’s office to verify coverage for you, and they will check the system to see how much coverage you are allowed. You might prefer to wait for your updated Medicare dental coverage to kick in, or you could ask the service center if they can make an exception given your dental history. You could call the service center yourself, and they will let you know if they have any information on your coverage. You might need to file a complaint with the Medicare board, and they could come to a decision about your coverage so that you are not waiting for an appointment that is not coming.

Conclusion 

You have every right to check your updated Medicare dental coverage when getting ready for your next appointment. You likely have many questions that could be answered by the Medicare service center, and you could call your dentist to check your coverage. You are allowed two routine appointments, and all the fillings are covered. You can obtain coverage for your implants or major procedures, and you might want to purchase a supplemental plan to pay for any gaps in coverage. Your supplemental coverage must be purchased from an independent party, and your dentist’s office will file both claims on your behalf. Much of your dental care is covered, but you must make certain that it is all covered before making an appointment.