Dental care needs can be costly and an overwhelming medical burden for many patients. It can even be more distressing when the patient is not covered by a medical insurance provider that caters for dental illnesses. Medicare is a federal government-run health insurance program that targets senior citizens aged 65 and above. Medicare also covers Americans that have special disabilities like end-stage renal diseases.
Since its establishment in 1965, Medicare has not sufficiently included dental services as a primary cover, despite it being a critical medical need that is relatively expensive. As we shall see in this article, some parts of Medicare plans provide dependent dental care coverage. There are amendment proposals to the Medicare policy to include dental care by Democratic legislators. The Medicare Dental Benefit Act of 2022, passed by Congress, and enacted in January 2023, offered some level of dental coverage for Medicare treatment.
The Act marked only the first time a Medicare program partly catered for dental care. Treatment covered by the new legislation includes dental examinations, X-rays, dental cleanings, and primarily dental surgeries like fillings. A study from the Kaiser Family Foundation shows that just over 24 million people under the Medicare program do not have dental care coverage.
The legislation passed by the lawmakers will see over 62 million people get dental care included as a basic healthcare benefit, just like other health needs that are primarily covered. The regulations in the amendments significantly expanded coverage of dental services and established a progressive yearly program that will lead to a wider range of coverage in dental care.
Medicare Covers for Dental Services is Generally Limited
It is helpful that a patient understands that Medicare may not provide coverage for any dental services that develop after the initial dental issue has been addressed and treated fully. All follow-up dental problems will require the patient to meet treatment costs. To illustrate this further, consider a patient involved in an accident with a tooth extraction as part of the treatment.
Medicare will meet the extraction cost. However, the plan will not cover any related dental needs that the patient may need, like tooth replacement due to the extraction. Additionally, Medicare covers particular dental issues that require hospitalization. The plan can pay for the examination required by a patient undergoing a dental procedure due to a threatening serious health condition.
In such cases, Medicare can cover the hospitalization costs, such as X-rays and anesthesia but not the dentist and treatment fees. The plan does not cover any dental services excluded from Original Medicare, even if one is hospitalized. This is one of the Medicare aspects that the legislation attempts to address.
Circumstances under Which Medicare Partly Covers Dental Care
The costs of dental care are borne entirely by the patients, including restorative procedures like crowns, dentures, extraction of the tooth, tooth extraction and filling, and dental cleaning. Original Medicare currently does not cover most dental procedures, dental care, and dental supplies. However, costs for particular dental services are paid by Medicare Part A as long as a patient stays in the hospital for a period of time.
To What Extent Does Medicare Advantage Over Dental Care?
Also referred to as private companies, they offer Part C Medicare Advantage plans through the approval of the federal authorities. The Part C plans usually cater to the medical needs gaps not covered by Original Medicare, such as eye care, dental coverage, and hearing illnesses. The premiums are higher than for other plans.
It is important to note that an individual’s Part C plan is normally personalized and can differ from others. Some Medicare Advantage (Part C) plans do not cover dental care, and one must understand their plan well. Part C plans are presently the best route to get dental care coverage through private insurers at a higher cost, especially for coinsurance services.
The private insurers offer an opportunity to willing patients to purchase other separate dental plans. Under Medicare Advantage, there is Medicare dental coverage like the Aetna Medicare Advantage that covers dental coverage care in preventive services like cleaning, direct enrollee reimbursement allowances, and supplements benefits that are not compulsory.
Most Medicare Advantage beneficiaries have dental care coverage, and only a few of those, about 13–14%, enjoy preventive coverage like dental cleanings, oral examinations, and X-rays. A person can subscribe to a Medicare Advantage plan immediately after becoming eligible for Medicare and during enrollment.
Premium Costs for Dental Coverage under Medicare Advantage Plan
Cheaper Medicare Advantage covers only dental checkups and cleanings, while costly plans cover complex dental care such as dentures and extractions. Some dental coverage premium plans have a 0$ monthly premium depending on the state where one lives. The premiums can be as high as $302 monthly in Eastern Pennsylvania and $397 in Los Angeles.
Other Medicare Plans that Partly Cover Dental Care
Medicare Supplement Plans
Medicare Supplement Plan is also called Medigap Plan and does not essentially cover dental care. However, Medigap (as the name suggests: gap) fills the gap by covering out-of-pocket costs such as deductibles and coinsurance. Private insurers provide selectable options, including dental care, with extra premiums.
Due to the out-of-pocket payments, many enrollees consider a stand alone dental plan that offers exclusive dental coverage. Another option for patients who cannot maintain a Medigap plan usually go for the less expensive Medicare Advantage plan. Any US citizen can enroll in a Medigap any time of the year, although the best rates are offered when a person becomes eligible for the first time.
States determine how much is to be paid for dental care coverage under Medicaid. Also, states have the final say on which dental services an adult can benefit from under Medicaid, although the plan has to include children’s dental needs. The attractive element of this cover is that it covers emergency dental problems, albeit with low numbers of adults covered.