Although Medicare does cover quite a bit of durable medical equipment, dental care is something that Medicare generally neglects to provide coverage for regardless of your dental condition. Learn more about the types of services that Medicare covers right in this guide.
Medicare Provides Some Types of Dental Services
Medicare doesn’t provide coverage for routine dental services like teeth cleanings, routine dental checkups or fillings for cavities. There are certain circumstances where Medicare does offer limited dental services including for exams needed before kidney or other organ transplants or during surgeries to repair a portion of the jaw or face. Medicare also offers dental services when radiation is required for diseases related to the jaw including oral cancers.
Medicare Offers Dental Services When Combined With Advantage Plans
A Medicare Advantage plan might be a good choice for anyone who needs vision and dental benefits along with medical benefits. A Medicare Advantage plan or a Medicare Part C plan usually covers certain dental benefits like cleanings, fillings and routine dental care. Most of the Medicare Advantage plans do not cover braces, but do cover dental procedures including preventative care, restorative care, cleanings, x-rays and implants or dentures. Additional dental coverage might be purchased to cover orthodontic expenses.
Medicare Versus Medicaid
Medicare and Medicaid are two different types of medical insurance. Medicare is a Federal health insurance program designed for people over the age of 65. Medicaid is a federal and state health insurance program offered to people who have a very low income. Unlike Medicare, Medicaid insurance does offer dental coverage for both adults and children — depending on the income level of the family. Most Medicaid dental coverage for adults varies greatly by state and the type of coverage offered.
Does Medicaid Provide Dental Coverage for Braces?
Children with Medicaid insurance as their health insurance are entitled to dental coverage that includes routine examinations, cleanings and restorations along with other needed procedures. In many cases, patients with Medicaid can get braces — if the braces are considered medically necessary.
Using Medicaid Benefits for Braces
In order to use your Medicaid benefits for braces, you’ll need to choose an orthodontics office and ensure it adheres to the Medicaid fee schedule. The braces are considered medically necessary if you have certain conditions such as these:
- cleft palate
- problems chewing or eating in a normal manner
- speech impediments due to tooth and jaw structure
- severe crossbites, underbites or overbites
If the braces are cosmetic rather than medical, Medicaid generally will not cover their cost.