Does Medicare cover dental services?

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Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. In rare cases, Medicare Part B will pay for certain dental services. In addition, Medicare Part A will pay for certain dental services that you get when you are in the hospital.

Some Medicare Advantage plans may include dental benefits.

Learn more⇒

questions.medicare.gov

Medicare will pay when

  • you receive an oral examination in the hospital because you will be having a kidney transplant or in a rural or federally qualified health clinic before a heart valve replacement;
  • you have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
  • you had a facial tumor removed and had ridge reconstruction (reconstruction of part of the jaw) as part of that procedure;
  • you need surgery to treat fractures of the jaw or face;
  • you need dental splints and wiring as a result of jaw surgery.

While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated. For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.

Medicare will pay for some dental-related hospitalizations, for example, if

 

  • you develop an infection after having a tooth pulled;
  • you require observation during a dental procedure because you have a health-threatening condition.

Note: Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.

While Medicare may pay for in-patient hospital care in these circumstances, Medicare will never cover any dental care specifically excluded from Original Medicare (i.e., dentures), even if you are in the hospital.

Learn more ⇒

medicare inter active.org/

medical necessity

CMS General Explanation

 

Criteria to cover a procedure
TMJ, which may be related to trauma (such as a blow to the face),

As in any disease, an understanding of the natural course of the disease is necessary to guide treatment. Most symptoms resolve over time, but a significant percentage requires a year or more to do so. The seriousness of the symptoms also varies greatly. Consideration should be given to treatment options, the time course for resolution of symptoms, their seriousness, and the progressive nature of the disease. Treatment efforts are directed toward: 1) reduction of pain, 2) improvement of dysfunction, 3) slowing the progression of the joint disease. Temporomandibular joint arthroplasty is usually attempted after all nonsurgical methods of treatment have failed (AAOMS, 2001).

Conservative therapy is the mainstay in treating TMJ. This therapy may include behavior change, oral medications for pain, anti-inflammatory injections, and orthotic devices. Surgical treatments, often irreversible, may be recommended for difficult or unresponsive cases.

Learn more ⇒

anthem.com

Resources & Links

There is NO Pre existing condition clause in Medicare or Medicare Advantage Plans

Instant Dental Quotes

Dental questions.medicare.gov/

Federal Law on Medicare – Part A  law.cornell.edu/

Part B  aw.cornell.edu

(D)in the case of inpatient hospital services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, 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;  law.cornell.edu/

Exclusions

Fr_Blue_Plan_CA

partnership for solutions.org

 

Covereage Determinations cms.gov 

Kidney Transplant 260.6

Policy Manual    cms.gov web archive

Medicare Policy Benefit Manual cms.gov

Exclusions  cms.gov

Related Pages in Medicare Dental Section

3 comments on “Coverage for Dental Accidents under Medicare?

  1. Claims were submitted to BCBS of Florida who says we should have first submitted the claim to Medicare.
    What do you recommend?

    ****We’ve answered your question on this new page.

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