According to the Medicare Benefit Policy Manual by the Centers for Medicare & Medicaid Services (140 - Dental Services Exclusion (Rev. 1, 10-01-03) A3-3162, HO-260.13, B3-2336 ):
Items and services in connection with the care, treatment, filling, removal, or replacement of teeth, or structures directly supporting the teeth are not covered. Structures directly supporting the teeth mean the periodontium, which includes the gingivae, dentogingival junction, periodontal membrane, cementum, and alveolar process. However, payment may be made for certain other services of a dentist. The hospitalization or nonhospitalization of a patient has no direct bearing on the coverage or exclusion of a given dental procedure.
When an excluded service is the primary procedure involved, it is not covered regardless of its complexity or difficulty. For example, the extraction of an impacted tooth is not covered. Similarly, an alveoplasty (the surgical improvement of the shape and condition of the alveolar process) and a frenectomy are excluded from coverage when either of these procedures is performed in connection with an excluded service, e.g., the preparation of the mouth for dentures. In like manner, the removal of the torus palatinus (a bony protuberance of the hard palate) could be a covered service. However, with rare exception, this surgery is performed in connection with an excluded service, i.e., the preparation of the mouth for dentures. Under such circumstances, reimbursement is not made for this purpose.
The extraction of teeth to prepare the jaw for radiation treatments of neoplastic disease is also covered. This is an exception to the requirement that to be covered, a noncovered procedure or service performed by a dentist must be an incident to and an integral part of a covered procedure or service performed by the dentist. Ordinarily, the dentist extracts the patient’s teeth, but another physician, e.g., a radiologist, administers the radiation treatments. Whether such services as the administration of anesthesia, diagnostic x-rays, and other related procedures are covered depends upon whether the primary procedure being performed by the dentist is covered. Thus, an x-ray taken in connection with the reduction of a fracture of the jaw or facial bone is covered. However, a single x-ray or xray survey taken in connection with the care or treatment of teeth or the periodontium is not covered.
Items and services in connection with the care, treatment, filling, removal, or replacement of teeth, or structures directly supporting the teeth are not covered. Structures directly supporting the teeth mean the periodontium, which includes the gingivae, dentogingival junction, periodontal membrane, cementum, and alveolar process. However, payment may be made for certain other services of a dentist. The hospitalization or nonhospitalization of a patient has no direct bearing on the coverage or exclusion of a given dental procedure.
When an excluded service is the primary procedure involved, it is not covered regardless of its complexity or difficulty. For example, the extraction of an impacted tooth is not covered. Similarly, an alveoplasty (the surgical improvement of the shape and condition of the alveolar process) and a frenectomy are excluded from coverage when either of these procedures is performed in connection with an excluded service, e.g., the preparation of the mouth for dentures. In like manner, the removal of the torus palatinus (a bony protuberance of the hard palate) could be a covered service. However, with rare exception, this surgery is performed in connection with an excluded service, i.e., the preparation of the mouth for dentures. Under such circumstances, reimbursement is not made for this purpose.
The extraction of teeth to prepare the jaw for radiation treatments of neoplastic disease is also covered. This is an exception to the requirement that to be covered, a noncovered procedure or service performed by a dentist must be an incident to and an integral part of a covered procedure or service performed by the dentist. Ordinarily, the dentist extracts the patient’s teeth, but another physician, e.g., a radiologist, administers the radiation treatments. Whether such services as the administration of anesthesia, diagnostic x-rays, and other related procedures are covered depends upon whether the primary procedure being performed by the dentist is covered. Thus, an x-ray taken in connection with the reduction of a fracture of the jaw or facial bone is covered. However, a single x-ray or xray survey taken in connection with the care or treatment of teeth or the periodontium is not covered.
Medicare.gov:
Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices."
So, what does Medicare cover when it comes to dental health care?
A dental service that is an integral part of a covered primary service necessary to treat a non-dental condition, performed at the same time as the covered primary service, by the same physician/dentist, may be covered by Medicare. In these circumstances, only the dental procedure itself is covered. Medicare will not make a payment toward the cost of repairing teeth or structures directly supporting the teeth, dental appliances, dentures, or preparing the mouth for dentures.
Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
Additionally, these plans can be:
A dental service that is an integral part of a covered primary service necessary to treat a non-dental condition, performed at the same time as the covered primary service, by the same physician/dentist, may be covered by Medicare. In these circumstances, only the dental procedure itself is covered. Medicare will not make a payment toward the cost of repairing teeth or structures directly supporting the teeth, dental appliances, dentures, or preparing the mouth for dentures.
Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
Additionally, these plans can be:
- HMOs (Health Maintenance Organizations)
- PPOs (Preferred Provider Organizations)
- PFFS (Private Fee-for-Service) Plans
- SNP (Special Needs Plans)
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Dental Insurance
Be aware that individual dental policies often come with a waiting period for more extensive procedures. Therefore, if you’re purchasing the insurance to cover a major dental issue that you expect to occur in the near future, be sure to look for this provision to ensure that it will, in fact, pick up the expense.
Also, take the time to see which dental health professionals in your area accept the insurance you’d like to buy. This limits the likelihood that you’d have to change dental providers, but it also reduces the chance that you’ll mistakenly go to an out-of-network provider and incur even more dental costs.
Finally, review your selected dental policy thoroughly so you know exactly what it covers and how much you can expect to pay for the services you’ll need. At a minimum, this can help you decide which policy is best suited to you based on your specific oral health needs. It can also help you budget appropriately, simply by knowing how much your new plan will cover and how much you’ll have to pay on your own.
Also, take the time to see which dental health professionals in your area accept the insurance you’d like to buy. This limits the likelihood that you’d have to change dental providers, but it also reduces the chance that you’ll mistakenly go to an out-of-network provider and incur even more dental costs.
Finally, review your selected dental policy thoroughly so you know exactly what it covers and how much you can expect to pay for the services you’ll need. At a minimum, this can help you decide which policy is best suited to you based on your specific oral health needs. It can also help you budget appropriately, simply by knowing how much your new plan will cover and how much you’ll have to pay on your own.