Medicare and dental care: what to know before your visit

The question we hear every week

Many patients turn 65, get their Medicare card and ask us the same thing. Will Medicare pay for my teeth now?

The answer depends on which kind of Medicare you have. Some plans include dental. Many do not. One call to our office tells you where you stand. Bring your plan card, and we will check it with you.

What Original Medicare usually does not cover

Original Medicare is Part A (hospital) and Part B (medical). Most people start with it. Medicare.gov says that in most cases, it does not cover dental care. That includes:

• Routine checkups and cleanings
• Fillings
• Tooth extractions (pulling teeth)
• Dentures
• Dental implants

The few exceptions in Original Medicare

In a few cases, Original Medicare may pay for dental care. These cases are tied to a medical treatment Medicare already covers. They are not for routine care.

Medicare.gov gives some examples. An oral exam before a heart valve replacement. Treating a mouth infection, like pulling a tooth, before cancer treatment. Care for mouth problems during head and neck cancer treatment. Dental exams linked to dialysis for kidney failure. A hospital stay for a serious medical problem may also cover some dental care.

In these cases, you usually pay 20% of the Medicare-approved amount. This is after the Part B deductible, says Medicare.gov. If you think this applies to you, tell us and your doctor.

Medicare Advantage plans often include some dental

Medicare Advantage plans are also called Part C. Private companies offer them, with Medicare's approval. Medicare.gov says most of these plans offer extra benefits, like vision, hearing and dental.

But each plan sets its own dental benefits. One plan may include two cleanings a year and X-rays. Another may also help with fillings or dentures. Some have yearly limits. Some only work with certain dentists. Two neighbors in Kendall can have very different coverage.

So start with your plan card. The back usually has a phone number for member services. Sometimes there is a separate number for dental.

What about Medigap and supplemental plans?

Medigap is also called Medicare Supplement Insurance. It helps pay your share of Original Medicare costs, like deductibles and coinsurance. Medicare.gov says Medigap generally does not cover dental. So Medigap alone usually does not add routine dental care.

Many people also have a separate dental plan, or a supplemental plan with dental benefits. These are different from Medigap, and they can help a lot. We accept most insurance plans and most Medicare supplemental plans. Our front desk checks your benefits with you before treatment, so there are no surprises.

Not sure what you have? That is normal. Bring every card in your wallet, and we will sort it out together.

How to get ready for your visit

Before you come in:

• Find all your cards. Bring your red, white and blue Medicare card. Also bring any Advantage, dental or supplemental plan card.
• Call us at 305-271-1421 with your cards in hand. We will check what your plan includes.
• Ask your plan about yearly limits, waiting periods and which dentists are in network.
• Write down any pain, loose teeth or denture problems. We will talk about them first.
• Ask us about financing for care your plan does not pay for.

Care that fits your plan and your budget

We explain your options clearly and show you what your plan covers. Then we help you plan the rest. Financing is available, and dental implants start at $99 a month. This helps many patients replace missing teeth or move past loose dentures.

We have cared for families in the Kendall Mall since 1973. Many patients have been with us for decades. We are open Monday to Friday, 8 AM to 5 PM. For emergencies, you can call us 24/7.

Common questions

This article is general information, not medical advice. Your dentist will confirm what is right for you at your exam. General information checked against: medicare.gov, medicare.gov, medicare.gov.