Medicare and Your Dental Care: What You Need to Know About Coverage

by James on April 29, 2016 · 0 comments

hands-981400_640You’re getting older, and you live on a fixed income.

And yet, you have dental bills that need to be paid. What do you do? If you’re like most retirees, you need dental care at some point, but you’re not sure what — if anything — Medicare covers. Here’s what you need to know.

Medicare Dental Coverage

Medicare Parts A, B, and C do not cover any dental care. Unfortunately, these are the most common parts of Medicare that seniors pick up for their insurance needs. There is one exception to this rule, however.

Under special, limited, circumstances, Medicare Part C Medicare Advantage plan covers some forms of oral surgery when they involve a problem with the mouth or jaw bones or tissue. Medicare Part B or C plan might cover it too if the surgery is performed by a nonphysician oral surgeon as long it’s the kind of treatment that physicians normally perform.

It’s hard to get Medicare to pay for dental coverage because, under normal circumstances, they won’t pay for anything. Medicare Part B pays 80% of the Medicare-approved amount for covered oral surgery, but this is not dental care and it does not include basic cleaning services.

How To Get Medicare To Pay

When Medicare does pay for oral surgery, you need to meet two basic requirements. First, the surgery has to be medically necessary. You cannot be getting elective surgery or cosmetic care.

Usually, it’s pretty obvious when medical services are deemed “medically necessary” and thus covered. Medicare Part A, B, or C (which is a private Medicare Advantage Plan) may deny coverage that you expect to be covered. Common issues include:

  • You repeat a procedure when it was unsuccessful or only temporarily or partially successful. Insurance will often refuse to cover the second surgery because the first one was not deemed successful. Under the Medicare rules, the condition was already considered “treated” even when it was not completely successful.
  • When you undergo screening or diagnostics more frequently than Medicare’s normal time frames permit. For example, females cannot get mammograms more than every 12 months. If you go more often than this, services will not be covered.
  • You continue or begin ongoing services, like nursing facility or in-home care without meeting all the requirements. Some nursing homes provide dental coverage as part of the care package. But, you won’t be able to take advantage of this if you do not meet the basic requirements for Medicare to be put under skilled nursing care.

There are other gray areas where coverage may be denied as well. When you need oral surgery, you will likely need your doctor’s approval, and a recommendation that this is the only, or at least the best, option for you.

Of course, you can help your situation by recognizing when there might be a problem. Discuss the service with your doctor before you get the procedure done. If you have any doubts as to whether it’s covered, ask your dentist. Medicare and Medicare Part C rely on your doctor’s notes about your condition before they make a decision about whether services are covered. Bringing up the conversation with your doctor or dentist before surgery might help you and your doctor determine whether the procedure is medically necessary under Medicare’s rules.

And, if you can establish medical necessity beforehand, it increases your odds that the procedure will be covered.

You should also ask your doctor to contact Medicare beforehand to ask about your medical condition. He or he can determine whether a procedure is medically necessary and, even if it isn’t, your doctor can contact Medicare and request approval of coverage before the surgery. That way you’ll know beforehand whether it’s covered or not.

Paying For Regular Services

Because Medicare does not cover basic cleaning and other dentistry services, you will need another option for that.

If you need help paying for basic dental care, you should visit Carefree Dental online to learn more about discount plans which can supplement your Medicare coverage. These plans are not insurance, not associated with Medicare, and do not replace your insurance coverage.

They are discount plans.

Like insurance, the plan includes a network of dentists that have agreed to discount their services to plan members. Unlike insurance, there are no claim forms and the plan does not pay for any covered services. The benefit of joining a discount plan is that you pay less than you otherwise would for covered services.

Cerys Morris is a busy dental hygienist. She wants to encourage everyone to have a healthy mouth by sharing her insights online. Look for her posts on dental and wellness blogs.

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