Navigating dental care through Medicare can be confusing, as typical services like cleanings, fillings, and dentures aren't covered. However, there are specific situations in which Medicare steps in to support necessary dental care.
Limited Dental Coverage Under Medicare
Medicare doesn’t cover routine dental care but may cover specific procedures tied to medical conditions. Coverage applies when hospitalization is required for a dental issue, pre-treatment exams are needed for major medical procedures (e.g., organ transplants, chemotherapy), or when managing complications from cancer treatments.
Understanding Out-of-Pocket Costs with Original Medicare
Medicare doesn’t cover routine dental care, so you pay 100% of those costs. For Part A inpatient dental treatments, costs include a $1,632 deductible (Days 1-60), $408/day (Days 61-90), and $816/day after that using lifetime reserve days. Part B covers 80% of approved dental services after the deductible. Orthodontic care isn’t covered unless medically necessary due to an accident or illness.
Planning Ahead
Medicare does not cover routine dental care, making it essential to explore supplemental insurance or standalone dental plans for comprehensive coverage. Being aware of Medicare’s dental criteria allows you to make informed decisions, ensuring your oral health needs are met while avoiding unexpected expenses.