YOU ASK:

Does Medicare cover dental when health is threatened?

WE ANSWER:

Under normal circumstances (the patient's health is not threatened), Medicare does not cover dental treatments. This includes routine dental check-ups and the usual dental treatments such as dental fillings, dentures or tooth extractions. Medicare will also not pay for routine treatment or replacement of structures that support teeth, such as the alveolar bone, the dentogingival junction, the periodontal membrane and so on.

However, when a dental treatment is medically necessary in order to save a person's life, it may be covered by Medicare under certain conditions, namely:

  • The dental procedure done to the patient must be part of the treatment for the covered sickness or illness for which the patient was hospitalized.
  • The dental procedure is only a secondary yet integral part of the primary service that is covered by Medicare. The primary service should be a non-dental procedure. An example of a covered dental service would be a teeth examination before the surgeon does a heart valve or kidney transplant. This is covered because the purpose of the service was to check whether there would be complications that will affect the results of the surgery, such as the possibility of infection.
  • The dental procedure should be done by the doctor or physician treating the covered illness.
  • The dental procedure should be done at the same time as the primary service. For instance, Medicare will pay for teeth extraction when this is needed to treat a tumor located in the jaw.

Medicare will not cover dental appliances such as dentures, even when these are consequences of the primary treatment. For example, if a covered surgery resulted in the removal of some teeth, Medicare will pay for the surgery but not for the dentures or any dental appliance.

The following are some instances where Medicare may cover (up to certain limits) dental treatments:

  • The wiring of the teeth as part of the treatment of a jaw injury.
  • The teeth and jaw are reconstructed as part of the treatment for accidental injury.
  • Reconstruction of the jaw or the ridge due to a surgery involving the removal of a tumor.
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