What dental care is covered by Medicare? According to the Centers For Medicare Services, dental services are those “that the individual may need at some time in the course of his or her life.” Those services would include routine oral examinations and the provision of preventative services. A qualified oral hygienist who is licensed to do so is usually a participating provider in Medicare. To be categorized as a participant in Medicare Part A and B, the individual must also have a participating primary care physician who is accessible at reasonable intervals to provide medical advice and guidance for the management of oral health.
The list of services provided under Part A is broad and covers most types of major dental and surgical procedures; however, it does not cover most cosmetic procedures, certain hair transplants, some dental implants, certain dental devices, such as retainers, and some dental reconstructive surgery. Part A coverage of dental services is measured according to frequency and cost. Major oral health services are generally covered when you have one regular primary care physician and any necessary referrals. The rest are covered at the discretion of the participant.
As a part of what dental services are covered by Medicare, there are two other areas that are not addressed by this coverage. They are, in vitro blood and tissue culture, and elective surgeries for improving the appearance of the face. Because there is no requirement that a patient undergo an oral examination, it is impossible to know what services are covered by Medicare. Any service that would be covered if the patient were to get an examination will be covered by the fee for Medicare. In vitro blood and tissue culture services are usually covered only after a referral is made to the appropriate center from Medicare.
According to the website for the Medicare Supplement Insurance Plan (FSIP), the categories of services that are covered by Medicare that are not addressed by Part A are those that are not directly related to an “essential benefit.” These are listed in the “other benefits” section. These categories of services include mental health services, accident-related services, home health services, professional services, hospital services, professional liability insurance, durable medical equipment, optometry services, and interpretive services. The purpose of this portion of the plan is to create flexibility in selecting the types of coverage that are most beneficial to the applicant.
In addition to what dental services are covered by Medicare, it is important to know what providers are covered by the government as well. If you need more information about the government’s coverage programs for dental care, you can visit the Medicare website. Among other things, you will be able to learn about eligibility requirements, what services are offered, and what providers are available. If you do not qualify for the programs, you may qualify for supplemental security income (SSI) or a Medicaid Waiver. Both of these programs are offered in states that have not expanded their Medicaid programs.
One category of services that is considered essential to obtaining insurance coverage is oral surgery. It is important to note that there are two different types of oral surgery: corrective and preventive. The corrective surgeries are used to correct issues related to either the structure of the teeth or the gums. For example, if a person has missing teeth, they may be required to have their teeth filed. Preventive services help to reduce the risk of developing cavities and improving the mouth’s overall health.
Some procedures that are covered by Medicare are dental procedures that address both the mouth and jaw. These may include braces, appliances that straighten the teeth and clear out the front, and other specialized services. It is best to check with a certified dental assistant or private physician to make sure that any oral surgery that you are considering will be covered by your coverage. If the procedure will require additional treatment after you have received treatment from a primary care physician, it may be covered by your coverage or may have additional fees assessed.
When considering what dental services are covered by Medicare, it is also important to consider what services are not covered. Although many of the services commonly performed are ones that most people will agree are essential, such as braces and tooth whitening, some elective surgeries may not be covered. It is best to contact a representative from your supplemental agency for information regarding what dental services are not covered by Medicare.