Does medicare cover medically necessary dental work

Q: Will Medicare cover dental implants if medically necessary?

The Medicare law doesnt allow for coverage of dental care or services needed for the health of your teeth, including cleanings, fillings, dentures and tooth extractions. This also includes dental implants.

Q: Does Medicare cover dental in 2022?

Medicare doesnt cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices). Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Can Medicare Part B cover dental expenses? Yes and no. While Part B is an important part of your Medicare health insurance coverage, it may still leave you unprotected for services you still need.

Table of Contents Show

Does Medicare Part B Cover Any Dental Expenses?
What Dental Services Are Covered by Medicare Part B?
Medicare Part A
Medicare Part B
Medicare Part C (Medicare Advantage)
Medicare Part D
Medicare Supplement (Medigap)
Which of the following parts of Medicare determines eligibility for dental services?
Will Medicare cover dental implants if medically necessary?
Does Medicare cover dental in 2022?
Is oral surgery covered by Medicare?

Original Medicare has two Parts — A and B. While Part A covers your hospitals, Part B covers many outpatient medical expenses, including doctor's visits, preventive services, and mental health services.

Those who qualify for Medicare can expect many of their health needs to be covered by Medicare, but not all of them.

Services that extend beyond hospital and doctor visits may not be covered, including dental. But there may be a way to get the Medicare Part B dental coverage needed under the right circumstances.

Does Medicare Part B Cover Any Dental Expenses?

Yes, but Medicare Part B only covers dental expenses that are a medically necessary part of another covered service. It does not cover routine dental services, such as cleanings, or other standard procedures like dentures, crowns, or fillings.

In fact, approximately 24 million Americans on Medicare do not have dental insurance that covers these services.1 These services would need to be covered through independent senior dental plans or through a Medicare Advantage plan that includes dental coverage.

What Dental Services Are Covered by Medicare Part B?

While there's no coverage for the regular care, treatment, removal, or replacement of teeth, Medicare Part B dental coverage does cover dental services performed by a physician that are an integral part of another covered procedure. Examples include:

Oral exams in anticipation of a kidney transplant.
Extractions done in preparation for radiation treatments involving the jaw.
Reconstruction of the jaw following an accident.
Outpatient exams required before an oral surgery.

Because none of these cases are preventative or common dental treatments, it would be beneficial for Medicare beneficiaries to invest in a stand-alone dental plan to help subsidize the cost of receiving the regular dental services that are essential to maintaining oral health. Services such as cleanings, fillings, tooth extractions, dentures, dental plates, and regular dentist visits are not covered by Medicare Part B or Part A.

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References:
1.“Medicare and Dental Coverage: A Closer Look.” KFF. July 2021. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/

If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs.

While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage.

Let’s explore which types of oral surgery Medicare covers and why.

Oral surgery is sometimes required as part of the treatment plan for a medical condition, such as cancer or heart disease. In these instances, an oral surgery would be classified as a medically necessary procedure.

Some examples of when oral surgery is covered include:

Extraction of a damaged or diseased tooth may be medically necessary prior to starting radiation treatment. This may help reduce the risk of mandibular (bone) death.
To avoid getting an oral infection, extraction of a damaged or diseased tooth may be required prior to having an organ transplant.
If you have a fractured jaw and you need surgery to repair or restore it, Medicare will cover those costs.
Medicare will also cover oral surgery if your jaw needs to be repaired or restored after the removal of a tumor.

Since each situation is different, talk to your doctor or review your plan’s specific criteria, in order to determine if your oral surgery will be covered by original Medicare.

Medicare Part A

If you know that you will require a medically necessary oral surgery to treat a medical condition, you may get coverage under Medicare Part A if you are a hospital inpatient.

Medicare Part B

If you need to have medically necessary oral surgery performed on an outpatient basis, Medicare Part B may cover it.

Medicare Part C (Medicare Advantage)

If you know that you will require oral surgery for dental health, a Medicare Advantage plan (Medicare Part C) that covers routine dental procedures may be best for you.

However, not every Medicare Advantage plan includes dental services.

Medicare Part D

Required medications such as those to treat infection or pain will be covered under Medicare Part D, unless they are given intravenously.

If you are given medications in a hospital setting that are given intravenously, Part B will cover those costs. Most Medicare Advantage plans cover the cost of medications as well.

Medicare Supplement (Medigap)

Medigap may cover your Part A deductible and coinsurance costs if you have a medically necessary oral surgery performed in a hospital. Medigap does not cover these costs for oral surgeries required for dental health only.

If you have an oral surgery procedure that is not considered medically necessary, you will incur all of the costs associated with it.

If your oral surgery procedure is medically necessary, there are still costs you may have to pay. For example:

Copays. Medicare will cover 80 percent of the Medicare-approved cost of a medically necessary oral surgery, provided that it is performed by a Medicare-approved provider. If your procedure is done in a hospital and you do not have additional Medigap insurance, you will be responsible for 20 percent of the cost.
Deductible. For most people, Medicare Part B has an annual deductible of $203 that must be met before any services, including medically necessary oral surgery, will be covered.
Monthly premium. Medicare Part B has a standard, monthly premium rate of $148.50. This may be less for you if you are currently getting social security benefits, or it may cost you more depending on your current income.
Medications. You must have Medicare Part D or another type of drug coverage to have all or part of the cost of your medications covered. If you do not have drug coverage, you will be responsible for the cost of any medications required.

Routine dental services and oral surgery procedures required only for dental health are not covered by original Medicare. But oral surgery that is needed for tooth or gum health may be covered by some Medicare Advantage plans.

If you need a medically necessary oral surgery for medical health reasons, original Medicare may pay for the procedure. Even so, you may have out-of-pocket costs to pay.

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Which of the following parts of Medicare determines eligibility for dental services?

Original Medicare does not cover routine dental care. Medicare Part A and Part B will only cover dental services if they are required for another medical procedure and a physician deems them medically necessary. Additionally, Medicare Part A and Part B may cover dental work as a part of or related to an emergency.

Will Medicare cover dental implants if medically necessary?

The Medicare law doesn't allow for coverage of dental care or services needed for the health of your teeth, including cleanings, fillings, dentures and tooth extractions. This also includes dental implants.

Does Medicare cover dental in 2022?

Medicare doesn't cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices). Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Is oral surgery covered by Medicare?

Medicare will cover 80 percent of the Medicare-approved cost of a medically necessary oral surgery, provided that it is performed by a Medicare-approved provider. If your procedure is done in a hospital and you do not have additional Medigap insurance, you will be responsible for 20 percent of the cost.