Dental coverage and Medicare have a complicated relationship. As a general rule, Congress created a dental exclusion in 1980, but it made an exception for inpatient hospital services when the dental procedure itself made hospitalization necessary.
Coverage is not determined by the value or the necessity for the dental care but by the type of service provided and the anatomical structure on which the procedure is performed. Therefore, separate dental coverage may be necessary in many cases in addition to Medicare.
Currently, Medicare will pay for dental services that are an integral part either of a covered procedure. For example, reconstruction of the jaw following accidental injury will be covered. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician.
The following two categories of services are excluded from coverage:
- A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth such as preparing the mouth for dentures, removal of diseased teeth in an infected jaw.
- Medicare does not make payment for the cost of dental appliances, such as dentures.
Medicare will, however, pay for the extraction of teeth to prepare the jaw for radiation treatment of jaw diseases. An oral or dental examination performed before inpatient surgery may also be paid for by Medicare in certain circumstances.
It is important to speak with your Medicare provider and your doctor or dentist before any major procedure to make sure that you have coverage.