Original Medicare doesn’t cover dental procedures apart from the emergency dental services someone might receive in a hospital. Medicare Advantage, sometimes called Medicare Part C, combines Medicare Part A and Part B, and it often includes additional services not offered through the original plans, such as dental work. The main types of Medicare Advantage plans that cover dental work are HMOs, PPOs, PFFSs, and SNPs. If an individual has one of these plans, there’s a reasonable chance that their insurance includes dental services. Providers are not required by law to offer these additional benefits, so seniors shouldn’t assume that a visit to the dentist for a checkup will be covered.
Seniors should contact their Medicare provider to determine which types of dental work are covered in a plan. Most dental plans cover basic services, such as:
Some Medicare Advantage plans cover more comprehensive dental services. If not, providers will often offer supplemental plans that can be added to a Part C plan at an additional cost.
If a provider covers dental services as part of their plan, seniors don’t have to take any additional steps besides visiting a dental office or dentist within their network. Some Medicare Advantage plans don’t cover out-of-network physicians at all, while others may cover a smaller portion of the charges. Seniors can still visit one of these offices if necessary, but they will likely pay more for their visit.
A co-pay is usually charged for the visit, and Medicare covers the rest of the fees, and payment is either made before the visit or once a bill is received in the mail. What an individual pays is dependent on the terms of their plan.
If a Medicare Advantage plan doesn’t cover dental work, the beneficiary will have to pay all of the costs for their dental visit, unless they have subscribed to an additional plan that their provider offers to fill the gaps of Medicare Advantage. Those whose dental work isn’t covered may want to search for another Medicare provider or call their current provider to inquire about alternate plans.
Not all Medicare Advantage plans cover dental services, but many do. Before scheduling a trip to the dentist’s office, it’s a good idea to review dental plan coverage.