Common Medicare-Related Questions
Our office is a certified Medicare provider. So what does Medicare cover and how can it benefit you? Read on for answers.
Medicare does not cover “dental issues.” It will not pay benefits towards anything tooth-related (such as fillings, extractions, dentures, etc.). But it DOES cover medically necessary oral surgery that is needed due to jaw inflammation, infection, resorption of bone and inability to chew food.
What is Medicare? Medicare is a health insurance that provides benefits for patients over the age of 65 who have a “medical necessity.” If you have a condition that, if left untreated, would worsen and impact your well-being, then this condition may be covered, in part, by Medicare insurance. This can include major oral surgery services. There are conditions of coverage and exclusions and each patient must be evaluated individually to find out if they have a condition that meets “medical necessity” requirements.
Who can use their Medicare insurance for major dental services? If you have Medicare insurance Part B and a condition deemed a medical necessity, you may be eligible to have part of your oral surgery and dental implant treatment paid through Medicare. We have many patients who take advantage of this. There are multiple Medicare insurance plans in California and not every plan will pay for dental services. The only way to find whether you have an eligible plan and a condition deemed “medical necessity” is to come to our office for a personal consultation.
If you are covered, what may this mean financially? Many times these benefits have a major value in lowering your out-of-pocket expense. Medicare won’t cover all of the fees needed for treatment, but with specific conditions it’s not unusual to have 20-40% of fees paid –especially if you have a good supplemental policy. For some conditions, this translates to up to $6,000-8,000 per arch for oral surgery and implant treatment.
How do I find out which Medicare plan I have and whether I have a condition deemed a “medical necessity?” To see if you are qualified for a medical necessity and if you have oral disease, which will affect your long term health and well-being, you must be seen for an in-person consultation in our office. This consultation cannot be done by phone. To schedule a consultation, call
What if you find that my Medicare plan excludes dental services? Annually, you have the right to change Medicare plans. We will advise you on which plan to switch to so that we can get coverage for you.
How many dentists are credentialed as Medicare providers? Only 1% of dentists in the United States are Medicare providers who are credentialed (certified) to treat Medicare patients.
How many dentists in California can help me use Medicare insurance for dental implant treatment? Our doctors are just a few of the dentists credentialed in San Diego as a provider and who have a proven history of helping patients use their Medicare insurance under medical necessity provisions for dental implants.
What kinds of medical conditions are often deemed to have medical necessity? Oral disease is well documented in the medical literature to worsen many other organ diseases. This includes heart disease where mouth infection can contribute to heart attack, thrombosis (blood clots) leading to stroke, and vascular and valvular infection. Mouth disease adds to the risk of pulmonary (lung) infection and can contribute to serious pneumonia. Patients with COPD are at great risk of pulmonary infections from mouth disease. Patients with diabetes are at great risk of infections in other parts of their body as a result of bacteria from gum disease (pyorrhea). The mouth is a main target of diabetic infection and poor healing. Patients with GERD and other GI issues have many of these problems due to poor diet and not being able to choose healthy food groups for good nutrition. A recent study by the cancer society links colon cancer to periodontal (gum) disease and chronic infections in the mouth.
If you have any of these conditions and major dental disease, you may qualify for medical necessity and have a portion of major dental services covered.
Do teeth play a role in general health? Teeth in later life are essential for nutrition. Denture patients often become disabled from poor nutrition. Teeth firmly attached to dental implants give patients a better quality of life, even in the late stages of life. Many patients have shared stories of a loved one who would have had a much better quality of life if they had only had better teeth to chew with to contribute to better health.