Medicare and You 2019 #10050
Everything you want to know 

Medicare and You 2019 - Everything you want to know

When & How 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 hospitalmedicare.gov/dental

Some Medicare Advantage plans may include dental benefits.

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

Resources & Links
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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/

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

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

Child & Related Pages - Site Map 

Under 65 ACA preventative care

7 comments on “Dental Accidents & disease under Medicare?

  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.

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