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Do Medicare Advantage Plans Cover Dental?

May 28, 20233 min read

Do Medicare Advantage Plans Cover Dental?

Introduction

Medicare Advantage Plans, also known as Medicare Part C, are an alternative to Original Medicare, offering at least the same coverage. However, when it comes to dental services, the coverage can be a bit complex. This article aims to shed light on the extent of dental coverage provided by Medicare Advantage Plans.

The Basics of Medicare and Dental Coverage

Original Medicare, encompassing Part A (Hospital Insurance) and Part B (Medical Insurance), does not typically cover dental care. This includes procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. However, there are exceptions where Original Medicare may pay for some dental services closely related to other covered medical services.

For instance, Medicare Part A will pay for certain dental services that you get when you're in a hospital. This includes hospital stays if you need to have emergency or complicated dental procedures. It's important to note that the coverage is not for the dental care per se, but for the hospital stay related to the dental procedure.

Medicare Advantage Plans and Dental Coverage

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. These plans must provide at least the same coverage as Original Medicare, but they often pay for services that aren't covered by Parts A and B, including dental services.

The extent of dental coverage varies among Medicare Advantage Plans. Some may offer comprehensive dental coverage, including routine check-ups, cleanings, fillings, and even more complex procedures. However, others may only cover basic preventive services. It's crucial to check the specifics of your plan to understand what dental services are covered.

To determine if your current Medicare Part C plan covers dental, you can talk to a representative from the insurance company or read the details contained in the Evidence of Coverage (EOC) document you received when you enrolled in the plan.

Dental Coverage Exceptions in Original Medicare

While Original Medicare doesn’t generally cover dental care, there are some exceptions. If you need dental care because of an illness or injury that requires a hospital stay, your dental treatment may be covered.

For example, if you fall and fracture your jaw, Medicare may pay for the surgery to rebuild the bones in your jaw and fix any damaged teeth. Some complicated dental procedures are also covered if they’re performed in a hospital. Whether they’re covered by Part A or Part B will be determined by whether you’re an inpatient or an outpatient.

You may receive coverage if you need dental services because of oral cancer or another covered illness. Medicare may pay for a tooth extraction if your doctors think it’s necessary to remove the tooth prior to heart surgery, radiation therapy, or some other covered procedure.

Medigap and Dental Coverage

Medigap, also known as Medicare Supplement Insurance, helps cover some of the healthcare costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. However, Medigap typically does not provide coverage for extra services like dental care.

Conclusion

Understanding the extent of dental coverage in Medicare Advantage Plans can be complex due to the variations in coverage among different plans. While some plans may offer comprehensive dental coverage, others may only cover basic preventive services. It's essential to review your plan's specifics to understand what dental services are covered.

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