Medicare is known for not offering much dental coverage. Beneficiaries who keep Original Medicare, with or without a Medigap plan, must look to other forms of coverage, like a separate dental insurance plan. Considering the significant overlap between oral and systemic health, this is still surprising to most people when they enroll in Medicare.
We saw a few changes to Medicare’s dental coverage in 2024. We’ll review those today so you can decide if that coverage is sufficient or if you need to shop for dental insurance.
Medicare’s Dental Coverage in the Past
As we discuss Medicare’s dental benefits, we’ll refer to Original Medicare, meaning Part A and Part B. Medicare Advantage plans are separate from Original Medicare and may offer dental coverage. For now, we’ll focus on Original Medicare. Prior to 2024, Medicare’s dental coverage was nearly non-existent. We can narrow its coverage down to three services.
- When ridge reconstruction is required as part of (and in tandem with) the surgical removal of a tumor
- When teeth need to be extracted to prepare the jaw for radiation treatment of neoplastic disease
- When a dental examination is needed on an inpatient basis as part of a comprehensive exam before renal transplant surgery
Fortunately for many of us, those situations don’t often occur. For this reason, when asked if Medicare covers dental services, most insurance agents simply say, “No.”
It’s been reported that nearly half of all Medicare beneficiaries had not had a dental exam within a 12-month period (2018). Of those who were questioned, many said that cost was a barrier to care. These studies triggered providers, patient advocates, and members of Congress to ask the Centers for Medicare and Medicaid Services (CMS) to expand the coverage of medically necessary dental care. They’ve recognized the link between oral and systemic health and have noted that poor oral health exacerbates and complicates other medical issues.
Medicare’s Dental Coverage in 2024
The federal Medicare program did see some changes to dental coverage in 2024. While it has yet to expand benefits to routine and preventive services, it now covers more than it did in years prior.
The physician payment final rule clarified the interpretation of Medicare rules, codified payment policies, and defined new situations in which dental care would be covered by Medicare. Now, beneficiaries have dental coverage in the following scenarios.
- When a dental examination is part of a comprehensive exam before renal organ transplant surgery
- When dental ridge reconstruction is needed as a result of (and in tandem with) the surgical removal of a tumor
- When immobilization or wiring of the teeth is required in connection with a jaw fracture
- When teeth need to be extracted to prepare the jaw for radiation treatment for neoplastic disease
- When a dental splint is needed in conjunction with medically necessary treatment of a medical condition
As you can see, things haven’t changed much. CMS states that Parts A and B will cover dental services “that are inextricably linked to, and substantially related and integral to the clinical success of, certain other covered medical services.” The rule clarifies that coverage will only be available when medical and dental services are integrated. This would require your dentist and medical provider to communicate about the type of treatment you’re receiving.
The new rule also finalized when dental ancillary services are covered, such as anesthesia and x-rays. The law states that coverage will be provided:
- When diagnostic and treatment services to address dental or oral complications after radiation, chemotherapy, and/or surgery when used in the treatment of head and neck cancer
- When a dental exam is necessary for treatment, performed as part of a comprehensive workup prior to or at the same time as chemotherapy, chimeric antigen receptor (CAR) T-cell therapy, and the administration of high-dose bone-modifying agents (antiresorptive therapy) when used in the treatment of cancer
Add Dental Coverage to Your Insurance Portfolio
Unless you are comfortable paying out-of-pocket for dental services, you can tell that this extended dental coverage isn’t going to be enough. You can choose to get dental insurance through a Medicare Advantage plan, or you can add a separate dental plan to your insurance portfolio. Either option is great, provided you understand the pros and cons of each.
We encourage you to reach out to a Medicare advisor at Carolina Senior Benefits. Our team is experts in Medicare and can help you navigate these decisions. Call today to speak with a Medicare advisor near you!
