By David Forbes
Where are my Medicare dental benefits?
If you have asked this question, you are not alone. Many people who have become Medicare-eligible have either been surprised or dumb founded to learn, that for the most part, Medicare dental benefits are nearly non-existent. In fact, there are very few circumstances when Medicare will cover dental procedures.
Medicare is not comprehensive health coverage and there are several gaps that are the responsibility of the Medicare beneficiary. There is a mandatory deductible for hospitalization and 20% co-insurance required for outpatient procedures.
The Medicare legislation also includes a statutory dental exclusion. This exclusion states that:
"where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services."
In 1980 the exclusion was amended to allow Medicare dental benefits for inpatient hospital services when the dental procedure itself made hospitalization necessary. Medicare will also pay for dental services that are part of a covered expense. This could include reconstruction of the jaw due to an injury. Medicare dental benefits are also available for the extraction of teeth related to radiation treatment and in some cases will pay for an oral exam (but not treatment) prior to kidney transplants or heart valve surgery.
Medigap will not help - an Advantage plan may
Purchasing a Medigap insurance policy will not get you dental coverage. Medigap policies do not include dental benefits and only the gaps from a covered procedure will be paid. By definition, a Medigap policy will fill the gaps of Medicare covered claims, not offer additional benefits.
The only opportunity to receive dental benefits beyond what's included in Medicare, is to enroll in a Medicare Advantage plan that includes dental benefits. Not all Medicare Advantage plans include dental benefits and many that do, only offer discounts for certain
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