There is very little coverage for Dental Under Medicare

 

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 Doctor Visits will pay for certain dental services.  In addition, Medicare Part A Hospital will pay for certain dental services that you get when you are in the hospitalmedicare.gov/dental

Some Medicare Advantage plans may include dental benefits.

We did not in our research find any coverage under Medicare for Accidents!

Get Dental Quotes & Enroll ONLINE

Dental for Everyone.

Blue Cross Dental & Vision

Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental

Blue Shield Medicare Advantage Dental & Vision

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; See TMJ below
  • 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

Justice in Aging – Oral Health for older Americans 

 

Exclusions

partnership for solutions.org

Covereage Determinations cms.gov   –

Dental Exam prior to Kidney Transplant 260.6

Policy Manual    cms.gov web archive

Medicare Policy Benefit Manual cms.gov

Exclusions  cms.gov

Dental For Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

One of our colleagues on how Dental for Everyone Works
Sample Quote

Blue Cross Dental & Vision

Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental

Blue Shield Medicare Advantage Dental & Vision

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

.

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

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/

 

medicare.gov/dental-services 

Sample Quotes

Sample Quote – Click here for YOURS

 Buy Now

 7 days left to enroll

Careington Discount Dental Plan 

Participant$6.95/mo

Plus One$11.95/mo

Family$18.95/mo

Office Co-Pay:
N/A
Plan Deductible:
This is a Discount Plan.
Plan Maximum:
** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
Waiting You Pay
Cleaning None $39
Filling None $62
Crown None $505
Root Canal None Discount 20%

 Buy Now

 7 days left to enroll

Careington Discount Dental and Vision Plan with EyeMed Vision

Participant$7.95/mo

Plus One$12.95/mo

Family$19.95/mo

Office Co-Pay:
N/A
Plan Deductible:
This is a Discount Plan.
Plan Maximum:
** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
Waiting You Pay
Cleaning None $42
Filling None $66
Crown None $537
Root Canal None Discount 20%

 Buy Now

 7 days left to enroll

Careington Maximum Access Discount Dental Plan 

Participant$12.95/mo

Plus One$18.95/mo

Family$24.95/mo

Office Co-Pay:
N/A
Plan Deductible:
This is a Discount Plan.
Plan Maximum:
** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
Waiting You Pay
Cleaning None $29
Filling None $51
Crown None $473
Root Canal None Discount 20%

 Buy Now

 7 days left to enroll

Careington Maximum Access Discount Dental & Vision Plan with EyeMed Vision

Participant$14.95/mo

Plus One$20.95/mo

Family$26.95/mo

Office Co-Pay:
N/A
Plan Deductible:
This is a Discount Plan.
Plan Maximum:
** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
Waiting You Pay
Cleaning None $29
Filling None $51
Crown None $473
Root Canal None Discount 20%

 Buy Now

 7 days left to enroll

Dentaflex Advantage Plus PPO 

Participant$24.71/mo

Plus Spouse$36.41/mo

Plus Child(ren)$50.42/mo

Family$67.94/mo

Office Co-Pay:
N/A
Plan Deductible:
No Deductible
Plan Maximum:
$300 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%
Filling None 0%
Crown None 0%
Root Canal None 0%

 Buy Now

 7 days left to enroll

Max Essentials PPO

Participant$40.38/mo

Plus One$72.97/mo

Family$141.68/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services
Plan Maximum:
$750 per person per policy year
Waiting Plan Pays
Cleaning None 100%
Filling 6 months 50%
Crown None 0%
Ortho None 0%

 Buy Now

 7 days left to enroll

Dental for Everyone Gold Plan Delta Dental PPO

Participant$43.06/mo

Plus One$79.22/mo

Family$115.38/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year.
Plan Maximum:
$1000 per person per calendar year
Waiting Plan Pays
Cleaning None 60%-100%
Filling 6 months 50%-80%
Crown 12 months 0%-50%
Ortho N/A 0%

 Buy Now

 7 days left to enroll

Dental for Everyone Gold Plan Delta Dental Premier

Participant$53.80/mo

Plus One$100.15/mo

Family$146.51/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year.
Plan Maximum:
$1000 per person per calendar year
Waiting Plan Pays
Cleaning None 60%-100%
Filling 6 months 50%-80%
Crown 12 months 0%-50%
Ortho N/A 0%

 Buy Now

 7 days left to enroll

Dentaflex Select PLUS 1500 

Participant$54.41/mo

Plus Spouse$95.81/mo

Plus Child(ren)$109.39/mo

Family$163.23/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year. *The deductible is waived in-network on preventative services
Plan Maximum:
$1,500 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 100% / 70%
Filling 6 months 80% / 70%
Crown 12 months 60% / 50%
Root Canal 12 months 60% / 50%

 Buy Now

 7 days left to enroll

Dental for Everyone Platinum Plan Delta Dental PPO

Participant$54.48/mo

Plus One$101.49/mo

Family$148.51/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. Separate $100 lifetime for Orthodontic Procedures.
Plan Maximum:
$1500 per person per calendar year
Waiting Plan Pays
Cleaning None 80%-100%
Filling 6 months 60%-80%
Crown 12 months 0%-50%
Ortho 12 months 0%-50%

 Buy Now

 7 days left to enroll

Dental for Everyone The No Wait Plan Delta Dental PPO

Participant$56.44/mo

Plus One$105.30/mo

Family$154.17/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year
Plan Maximum:
$2,000 per person per calendar year
Waiting Plan Pays
Cleaning None 80%-100%
Sealants None 40%-80%
Crown None 15%-50%
Ortho N/A 0%

 Buy Now

 7 days left to enroll

Dentaflex Select PLUS 2000 

Participant$57.21/mo

Plus Spouse$101.41/mo

Plus Child(ren)$112.87/mo

Family$169.67/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year. *The deductible is waived in-network on preventative services
Plan Maximum:
$2,000 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 100% / 70%
Filling 6 months 80% / 70%
Crown 12 months 60% / 50%
Root Canal 12 months 60% / 50%

 Buy Now

 7 days left to enroll

Dental for Everyone Diamond Plan Delta Dental PPO

Participant$58.76/mo

Plus One$109.81/mo

Family$160.88/mo

Office Co-Pay:
$25 Copay Per Person Per Visit
Plan Deductible:
$150 lifetime deductible for Ortho
Plan Maximum:
$2,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
Waiting Plan Pays
Cleaning None 80%-100%
Filling 6 months 60%-80%
Crown 12 months 0%-50%
Ortho 12 months 0%-50%

 Buy Now

 7 days left to enroll

MAX Choice Plan PPO/MAC

Participant$58.78/mo

Plus One$106.24/mo

Family$158.59/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services and orthodontics
Plan Maximum:
$1,200 per person per policy year
Waiting Plan Pays
Cleaning None 100%
Filling None 20%-50%
Crown None 20%-50%
Ortho None 10%-50%

 Buy Now

 7 days left to enroll

Dental for Everyone Platinum Plan Delta Dental Premier

Participant$68.44/mo

Plus One$128.71/mo

Family$188.98/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. Separate $100 lifetime for Orthodontic Procedures.
Plan Maximum:
$1,500 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%-100%
Filling 6 months 60%-80%
Crown 12 months 0%-50%
Ortho 12 months 0%-50%

 Buy Now

 7 days left to enroll

Dentaflex Classic 1500 Plan 

Participant$69.23/mo

Plus One$123.96/mo

Family$218.63/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year.
Plan Maximum:
$1,500 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%
Filling 6 months 80%
Crown 18 months 50%
Root Canal 18 months 50%

 Buy Now

 7 days left to enroll

Dentaflex Classic 1500 Plan 

Participant$69.23/mo

Plus One$123.96/mo

Family$218.63/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year.
Plan Maximum:
$1,500 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%
Filling 6 months 80%
Crown 18 months 50%
Root Canal 18 months 50%

 Buy Now

 7 days left to enroll

Dentaflex Classic 2000 Plan 

Participant$73.72/mo

Family$132.83/mo

Family$235.08/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year.
Plan Maximum:
$2,000 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%
Filling 6 months 80%
Crown 18 months 50%
Root Canal 18 months 50%

 Buy Now

 7 days left to enroll

Dentaflex Classic 2000 Plan 

Participant$73.72/mo

Plus One$132.83/mo

Family$235.08/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per calendar year. $150 Family per calendar year.
Plan Maximum:
$2,000 Per Person Per Calendar Year
Waiting Plan Pays
Cleaning None 80%
Filling 6 months 80%
Crown 18 months 50%
Root Canal 18 months 50%

 Buy Now

 7 days left to enroll

Dental for Everyone Diamond Plan Delta Dental Premier

Participant$73.92/mo

Plus One$139.37/mo

Family$204.84/mo

Office Co-Pay:
$25 Copay Per Person Per Visit
Plan Deductible:
$150 lifetime deductible for Ortho
Plan Maximum:
$2,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
Waiting Plan Pays
Cleaning None 80%-100%
Filling 6 months 60%-80%
Crown 12 months 0%-50%
Ortho 12 months 0%-50%

 Buy Now

 7 days left to enroll

Dental for Everyone Immediate Coverage Plan Delta Dental PPO/Premier

Participant$85.44/mo

Plus One$161.83/mo

Family$238.24/mo

Office Co-Pay:
$25 Copay Per Person Per Visit
Plan Deductible:
$150 lifetime deductible for Ortho
Plan Maximum:
$3,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
Waiting Plan Pays
Cleaning None 80%-100%
Filling None 60%-80%
Crown None 10%-50%
Ortho 12 months 0%-50%

 Buy Now

 7 days left to enroll

MAX Choice Plus Plan PPO

Participant$89.49/mo

Plus One$163.15/mo

Family$230.57/mo

Office Co-Pay:
N/A
Plan Deductible:
$50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services and orthodontics
Plan Maximum:
Policy Year Maximum: 1st year-$1,000 2nd year-$2,000 3rd year-$3,000
Waiting Plan Pays
Cleaning None 100%
Filling None 20%-50%
Crown None 20%-50%
Ortho None 10%-50%

FAQ’s from Updated Webpage

 

6 comments on “Dental – Optional Coverage”

  1. How do I go about finding a participating dentist and optometrist, for the Blue Cross add on to their Medicare Advantage Plan
  2. Steve,

    I am thinking of changing dentists. The last time I looked into dental insurance with my old dentist it really didn’t work out as she was pretty much a private pay dentist. (She did take delta dental but somehow I don’t think the numbers worked out at the time.)

    I am thinking of going to a dentist who takes most ppo plans. I am pretty sure I have no dental coverage at present. (I would appreciate your double checking on that since I just switched to medicare with a supplement and am not sure everything that is covered.)

    1. Is dental insurance a good deal for me? I.E.

    2. how much would it cost and how much would it save me?

    I would appreciate it if you could let me know my options.

    Thank you in advance for your time.

    Jim

Child & Related Pages - Site Map 

Medi-Cal Share of Cost 

Dental For Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

One of our colleagues on how Dental for Everyone Works
Sample Quote

Blue Cross Dental & Vision

Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental

Blue Shield Medicare Advantage Dental & Vision

Introduction to all our websites

by Steve Shorr 
Bio

Introduction to Medi Gap and Medicare Advantage

Set Phone, Skype or Facetime Meeting

Our Webpage on

COVID 19

Corona Virus

8 comments on “Dental under Medicare is very limited

  1. I was at my daughters and playing with my 4 year old grandson when his head hit me in the mouth and knocked my front tooth out.

    Is this accident covered by Medicare or medi Cal?

    • I don’t see anywhere, where it seems to be covered under Medicare. Do you have a Medicare Advantage plan? Did you want to look into one? Try Checking with your dentist.

      Here’s our information on Medi-Cal Dental Medi-Cal dental benefits were fully restored in January 2018. If you have further questions on Medi-Cal Dental Benefits, please ask on that page.

      What county do you live in?
      What Medi-Cal Dental Program do you have? If you didn’t select a dental plan, you can probably do it now.

  2. I fell and hit my jaw. I went to the Dr. and x-rays and cat scan done. No broken bones. But I am having teeth pain that just comes and goes and pain in the joint of the jaw. If I go to a dentist or oral surgeon to determine if I did any damage to my teeth, is this covered?

    • Since it seems that your jaw wasn’t injured, my guess is no coverage. I simply reviewed the links above.

      Namely, it appears in your case Medicare only covers:

      Surgery to treat fractures of the jaw or face

      Which apparently you don’t have.

      I’m not a doctor, dentist or authorized Medicare employee. I suggest you check with your dentist.

    • I’m going to need more information as to why this was an “emergency.” Was this a

      temporomandibular-disorders/internal-temporomandibular-joint-derangement

      TMJ?

      Was there an accident?

      Trauma?

      Prior symptoms?

      Was this done in a hospital or dental office?

      What did your dentist say?

  3. 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.

Leave a Reply

Your email address will not be published.