Dental coverage and medicare have a complex relationship. As a general rule, Congress made a dental exception in 1980. The exception is for inpatient hospital services when the dental procedure requires hospitalization. The need for dental hygiene does not determine the coverage. It is determined by the sort of service provided and the anatomical structure where the procedure is done. Therefore, separate dental coverage may be necessary in many cases along with Medicare.
Presently, Medicare will cover dental services which is an integral part. Medicare will cover reconstruction of the jaw after accidental injury. Medicare will also pay for oral exams, but not treatment, or previous kidney transplantation or heart valve replacement. Part A covers these evaluation if done by a dentist on the hospital’s staff or under Section B if done by a doctor.
The next two types of services are not part of coverage:
- A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth like preparing the mouth for dentures, removal of diseased teeth in an infected jaw.
- Medicare does not make payment for the cost of dental appliances, like dentures.
Medicare will, however, cover the extraction of teeth to prepare the jaw for radiation treatment of jaw diseases. An individual must do an oral or dental examination before inpatient surgery may also be covered by Medicare in certain conditions.
It’s important to talk with your Medicare provider and your physician or dentist before any significant procedure to be certain that you have coverage.