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  Frequently Asked Questions

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Medigap

Does Medicare cover dental?

Medicare will not cover dental care that you need primarily for the health of your teeth.  For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings.  Medicare will never pay for dentures.  Even if Medicare has paid for you to have teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures.

Note: Some Medicare private health plans cover routine dental services.  If you have a Medicare private health plan, check with your plan to see what dental services may be covered.

However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare  covers to be successful.

Medicare will pay for dental services if, for example:

  • you receive an oral examination in the hospital because you will be having a kidney transplant or are in a rural or federally qualified health clinic before a heart valve replacement;
  • you have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
  • you had a facial tumor removed and had ride reconstruction (reconstruction of part of the jaw) as part of that procedure;
  • you need surgery to treat fractures of the jaw or face;
  • you need dental splints and wiring as a result of jaw surgery.

While Medicare may pay for these initial dental services, Medicare will not pay for any more follup-up dental care after the underlying health condition has bveen treated.  For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.

Medicare will pay for some dental-related hospitalizations, for example:

  • if you develop an infection after having a tooth pulled
  • if you require observations during a dental procedure because you have a health- threatening condition.

Note: Medicare will cover the costs of hospitalization (including room and board, anesthesia and x-rays).  It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.

Whle Medicare may pay for in-patient hospital care in these circumstances, Medicare will never cover any dental care specifically excluded from Original Medicare (ie. dentures) even if you are in the hospital.

See "Managing Dental Care Costs" under Medigap Press Releases.

 


 

 

 

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Board on Aging & Long Term Care
1402 Pankratz Street, Suite 111
Madison, Wisconsin  53704-4001
FAX:  608 246 7001
BOALTC@Wisconsin.Gov