YOU ASK:

Does Medicare pay for dental procedures?

WE ANSWER:

No, it does not.

Medicare excludes any dental procedure that is related to preventive care or to routine treatments. Thus, you can't expect Medicare to pay for dentures, fillings, dental check-ups and cleanings.

Dental treatment may only be payable for procedures that are directly related to a non-dental condition. These are for instances where dental services are needed in order to protect your general health or when your life is being threatened by a dental problem.

For example, Medicare will pay if you get an infection after you have a tooth extracted. Another example would be if you need treatment for a tumor located on your jaw, Medicare may pay for the tooth extractions involved. However, Medicare will not pay for dentures that you will need as a consequence of the tooth extraction.

Other conditions for dental procedures to be payable under Medicare would be that:

  • The dental procedure is done at the same time or during the duration that you are admitted in the hospital for your primary condition. The primary condition is the main reason for your hospitalization. For example, you are admitted to the hospital for a heart surgery. Medicare will pay for an oral examination in connection to the need to check whether your teeth may pose complications after the surgery. The dental exam is done during the time of your confinement for the surgery.
  • The dental procedure has to be directly related to or should be part of the treatment for the primary condition.
  • The physician providing the care for the non-dental illness will also be the one to do the dental treatment.

Even if some dental treatments are paid by Medicare, the follow-up check-ups and treatments are not payable.

You should note, though, that there are some Medicare private health plans that do provide for routine and preventive dental care. What's best is that you take a look at your Medicare plan to see whether dental services are included or excluded.

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