Medicare is a federally funded healthcare coverage program designed to help people with the expense of essential medical treatment. Unlike Medicaid, Medicare is aimed at people over 65 years old or who have a permanent disability. It is not necessary to be on a low income to qualify for Medicare. The program was brought into being to provide financial support to people who have greater than average medical expenses due to advanced age or disability.
Medicaid, on the other hand, targets people on a low income who may not be able to afford healthcare costs. If you qualify for Medicare and are also in the low-income bracket, you may be eligible for Medicaid benefits too.
Depending on the type of Medicare coverage you have, you may be able to use your plan to cover the cost of dental care.
Does Medicare Cover Dental Care?
Standard Medicare plans cannot be used to cover the cost of most dental care procedures, like tooth extractions, fillings, cleanings, dentures, orthodontic devices, or dental plates. However, Medicare Part A covers hospital treatment, which means that dental procedures carried out in a hospital — usually as a necessary aspect of treatment for another condition or injury — may be covered. For instance, if you require a dental examination prior to a transplant or a tooth extraction due to radiation treatment, this would likely be covered by Medicare.
Medicaid works a little differently. Depending on your state of residence and age, you may have some dental coverage on Medicaid. Every state is legally required to provide children from low-income families with dental coverage through Medicaid. However, adult coverage is usually patchy at best. As an adult on Medicaid, you may be able to get routine exams and other basic preventative treatments, but anything more than that will likely come out of your own pocket.
What Is Medicare Advantage?
Medicare Advantage is a type of healthcare plan offered by some private insurance companies in connection with Medicare. People who qualify for Medicare because of advanced age or a disability can choose to “upgrade” their Medicare coverage by paying into a Medicare Advantage plan. With this plan, Medicare pays a set monthly or annual amount to your insurance company to subsidize the cost of any treatment you require.
As you might imagine, Medicare Advantage plans cover a far more extensive range of treatments than standard Medicare. This usually includes vision, hearing, and dental care, though coverage will vary from one provider to another.
For this reason, it is extremely important to shop around and make sure your Medicare Advantage plan has been tailored to meet your needs. If you are likely to require a lot of dental treatment, finding a plan with good dental coverage is essential.
Which Dental Procedures Are Covered by Medicare Advantage?
Bearing in mind that no two Medicare Advantage plans are alike, most plans will cover a range of dental procedures that are not covered by standard Medicare. These procedures may include:
- Cleaning and hygiene services
- Oral x-rays
- Fillings and other restorative treatments
- Treatment of gum disease
- Root canals
- Tooth extractions
If you are likely to need dentures make sure your Medicare Advantage plan will cover this, as many do not.
As with all healthcare insurance plans, there are limits to what your Medicare Advantage will cover within a certain time frame. For instance, you may be restricted to two oral exams or one set of x-rays within a 12-month period.
What Does Medicare Advantage Cost?
The cost of your insurance plan will depend on the extent of your coverage. The more comprehensive the coverage, the higher your monthly premiums will be. Though it pays to keep in mind that coverage levels vary from provider to provider and that more expensive does not always mean better. As such, you will need to shop around to get the best Medicare Advantage dental coverage at the best price.
While you’re shopping around, keep in mind that some Medicare Advantage plans will stipulate that you may only use dentists within a given network. If you have your heart set on seeing a specific dentist or keeping your existing dentist, this must be taken into account.
Do All Dentists Accept Medicare Patients?
According to the American Dental Association, dentists can choose to opt in or out of providing Medicare services. As of 2019, around 43 percent of all dental care providers in the United States accept patients on Medicare, Medicaid, and CHIP.
Finding a dentist that accepts public healthcare coverage can be a challenge when less than half of all dentists in the country have chosen to opt in. Plus, many people who rely on Medicare live in rural and underserved areas, where they do not have the luxury of choosing a dental care provider.
What If Your Medicare Plan Does Not Cover Dental?
If you have just found out that your Medicare or Medicaid plan does not cover dental care, don’t panic. An easy way around this is to supplement your public healthcare coverage with an affordable dental insurance plan. Basic plans can be as cheap as $20 a month and most cover the cost of all preventative care.
There are other options for finding free or cheap dental care if taking out insurance is not viable for you. Contact your local health department to ask about free dental clinics and charitable organizations operating in your area.
How to Find a Medicare Dentist
The easiest way to begin your search for a dentist who accepts Medicare patients is to use an online directory to pinpoint dental care providers in your city or state. That being said, do not forget to ask your current dental care provider — if you have one — whether they accept patients on Medicare. If you’re lucky and they are among the 43 percent that do, you may not have to go through the hassle of finding a new dentist and switching providers.