Medicare Dental Coverage
Retirees thinking that Medicare will cover all of their health-related needs post-retirement should think again. With massive cuts to future entitlements, and predictions for more cuts in the future, the status of Medicare as a source for all-inclusive medical coverage is a lie, to say the least.
What Medicare Covers
Unfortunately for many underprepared seniors, the Medicare program does not provide dental coverage, and is instead created for the purposes of paying for high-cost treatment at hospitals and outpatient care facilities.
There are only a few services provided by Medicare for dental work; these include:
Injuries related to other health issues – While Medicare won’t pay for a basic teeth cleaning or checkup once per year, it will cover large expenses that are part of a greater medical concern. One example is a fractured jawbone, which may have happened as a result of falling up or down stairs. In most cases, the injury must be high-cost and undeniably related to your general health. Obviously a broken jawbone is a health issue that is more than just a chipped tooth, and Medicare will absolutely pay for such injuries.
Oral exams prior to treatments – The mouth is one of the few places of the body that is extremely responsive to changes in the digestive system, your diet, and dentists can tell in a matter of minutes what may be wrong in your internal organs with a fast mouth examination. Those with diabetes may be eligible to receive free dental check-ups to monitor how the mouth responds to changes in treatment. Also, dental check-ups before and after major surgery are almost always covered by Medicare.
Where the procedure takes place matters – Medicare is very much like a PPO in that it does not dictate to patients where they should seek treatment, though it will pay for services rendered at specific locations. A tooth extraction in a dentist office, for example, would not be covered by Medicare. However, the same extraction completed in a hospital setting would be covered 100%. If the treatment is not an emergency medical situation, be sure to call Medicare offices and the office of the physician or hospital to find out if Medicare will pay for your specific medical needs.
Insurance Options for Seniors
Older Americans looking to preserve the quality of their teeth well into their retirement years would be wise to consider private options for dental coverage. In many cases, discounts offered through national membership programs like the AARP allow for large discounts to the elderly population, and may have local programs designed to provide free or nearly-free routine dental services.
Matching an insurance product to your Medicare coverage is essential. Knowing that Medicare does not pay for dental work that is not considered to be a major medical emergency, it would be wise to purchase a small dental insurance policy on the side to spread any costs over the course of the year.
As mentioned earlier, small PPO networks often offer a PPO membership plan that provides two dental check-ups and 50% coverage of “level 2” (cavities, but not major extractions) services. Such a policy should cost no more than $30-50 per month, and they are routinely subsidized by assisted living facilities, churches, and membership societies that provide large discounts to their membership.
Because servicing these accounts is considered to be less than economical, it is rare that new applicants must submit dental histories or receive a check-up before being accepted. Instead, most everyone is accepted once payment is made, and coverage is rarely dropped. Instead, insurance companies that cater to the small monthly premium market price in such risks into the premium, saving Medicare patients the time, money, and trouble of dealing with verification to receive dental services.