Basically, Medicare does not cover dental procedures unless they are done as part of and directly connected with some other Medicare covered condition requiring hospitalization.
Whether a procedure is covered has no connection with the severity of the condition or the immediacy of the need. It has everything to do with what service is performed, where and when it is performed, and the physical structure involved in the procedure. A covered procedure must be performed as a secondary service that is an integral part of a covered primary service that is non-dental in nature. It must be performed at the same time as the primary procedure and by the same physician or dentist. When the covered procedure results in the need for dentures or other appliances those expenses are not covered, even though the need is a direct result of the covered procedure.
Examples of dental expenses that are covered would be:
- Removal of teeth or preparation of the jaw for radiation treatment of a tumor or growth.
- Examination of the teeth (but not the treatment of them) prior to kidney or heart valve transplant
To be covered, such procedures must be done on an in-patient basis, and as part of treatment of the larger medical condition, and at the same time.
Examples of dental expenses that are not covered would be:
- The care or treatment of teeth or structures supporting the teeth as a primary service
- Removal or replacement of teeth as a primary service
- The preparation of the mouth for dentures
- Removal of teeth in an infected jaw
- The repair of any supporting structures including all parts of the gums, tooth roots and their covering, and the alveolar bone which forms the tooth socket.
Medicare related programs take dental care into some account.
Privately paid dental costs are considered by Centers for Medicare & Medicaid Services in calculating a patient's out of pocket medical expenses.
Medicare Medical Savings Accounts (MSA) can be set up which may cover dental expenses. Individuals do not make deposits to such accounts. Funds are added only from your Medicare account. Such accounts are strictly controlled with a deductible that must be met from Medicare qualifying expenses before the account can be used. Medicare selects the bank where the account is created, and payments from the account are usually made via a debit card. Although some expenses from MSAs are taxed, dental expenses are not.
Social Managed Care Plans under Medicare are available to qualifying individuals in a very few cities, and these plans may provide dental care in addition to other long-term care services.
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