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. Show
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:
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. 46487-HM-1121 References: Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician. Statutory Dental ExclusionSection 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services." BackgroundThe dental exclusion was included as part of the initial Medicare program. In establishing the dental exclusion, Congress did not limit the exclusion to routine dental services, as it did for routine physical checkups or routine foot care, but instead it included a blanket exclusion of dental services. The Congress has not amended the dental exclusion since 1980 when it made an exception for inpatient hospital services when the dental procedure itself made hospitalization necessary. Coverage PrincipleCoverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed. Services Excluded under Part BThe following two categories of services are excluded from coverage: A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw. A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition (e.g., tumor removal) and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth (e.g., alveolar process). Exceptions to Services ExcludedThe extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease. An oral or dental examination performed on an inpatient basis as part of comprehensive workup prior to renal transplant surgery or performed in a RHC/FQHC prior to a heart valve replacement. DefinitionStructures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets). 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.
Why is dental care not covered by Medicare?Simply put, for a long time, dental work wasn't considered important enough to be covered by Medicare due to a lack of information and resources. The U.S. Centers for Medicare & Medicaid Services was established in 1965, and since then, little to no changes have been made to offer dental coverage.
Does Medicare Plan B cover dental?Original Medicare‡ Parts A and B do not cover dental care, except in certain circumstances. For example, if you're in the hospital for dental surgery, Part A will cover your inpatient costs. For other dental care, such as teeth cleanings and root canals, you will pay 100% of the cost.
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.
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Does social security pay for dental work
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