Emergency Dental Work for Patients on Medicare

If you’re on Medicare, you probably have questions about how it works with regards to dental work. For example: What’s covered? How do I get more benefits? And what happens if I don’t have dental insurance? So we’ll answer those questions in a friendly way so that you know what to expect if you need urgent dental care while on Medicare.

Please call 866-720-2809 to be immediately connected with an emergency dentist in your zip code for urgent dental care.

The Medicare insurance scheme covers dental services but in a limited way.

Medicare dental coverage is limited. The Medicare program assists in paying for a few types of dental care, but the services it covers are very limited. For example, it does not cover routine visits or cleanings. Nor does it cover most other types of procedures, such as fillings and root canals.

Medicare covers certain types of dentures, crowns, and bridges when considered medically necessary. It is called “medically necessary” care because it prevents further complications that could arise due to a lack of treatment.

Please call 866-720-2809 to be immediately connected with an with an office providing urgent dental care in your zip code.

In some cases, Medicare may cover a part of the cost of an urgent dental procedure under Part B.

You may get Medicare to cover a portion of your emergency dental treatment. Here’s what you need to know about getting urgent dental care if you have Medicare:

  • You can use a directory such as ours to search directly for emergency dentists in your state.
  • In some cases, Medicare may cover a part of the cost of an urgent dental procedure under Part B. It includes procedures like fillings and extractions that can prevent further damage to your teeth or gums if they are not treated promptly. You can call 866-720-2809 to be connected to a dental office near you based on your zip code.
  • You will have to pay for most other types of urgent dental care out-of-pocket. They are considered elective (non-emergency) services that aren’t covered by Part B.

Medicare dental care

Medicare does NOT cover cosmetic dentistry or orthodontics. It means your dentist can’t offer a fix if your teeth are stained from smoking or coffee consumption. Medicare also doesn’t cover any procedures related to implants or dentures.

Many people seek a secondary insurer to cover their medical and dental costs.

Secondary insurance (like MetLife Dental) is an additional type of health coverage that can help you pay for expenses that your primary plan doesn’t cover. For example, suppose you have Medicare and choose to get secondary insurance. In that case, you can use your secondary insurance to cover any costs that Medicare doesn’t cover.

Benefits of Secondary Insurance

  • You can pay for dental care at no cost or out of pocket.
  • You can sign up or change before next year’s open enrollment period. You can enroll whenever you want within the plan’s annual enrollment period (AEP).
  • There are fewer restrictions than with traditional dental plans offered through employers or other organizations, which could lead to a wider variety of options when choosing a provider or clinic (although this will depend on where you live).

What you should know

People with Medicare as their primary insurance should know what is and isn’t covered by their plan before they need urgent dental care.

First, it’s important to understand the difference between primary and secondary insurance. A person may have two or more types of insurance that cover different costs, depending on their treatment type. For example, suppose you have secondary coverage through your employer’s health plan. In that case, your dentist might bill them first for services rendered before billing Medicare. Suppose a person has Medicare and Medicaid as primary insurance (often called Medi-Medi). In that case, both programs typically pay for dental care. Still, Medicaid does not cover other medical expenses such as prescriptions or eye exams.

People with Medicare must be aware of what services are covered by their program to avoid unexpected out-of-pocket costs from providers outside their network—and there are many. In general terms:

What does all this mean for people with Medicare?

You want to ensure adequate coverage when a dental emergency strikes. In that case, it’s best to get supplemental insurance. It can help cover costs like crowns or root canals if necessary.

The other thing to consider is that sometimes Medicare does not cover dental care for certain procedures under Part B (like those mentioned above) unless they’re considered urgent or necessary.

Additional Supplementary Insurance Options

Medicare Advantage Plans (Part C):

  • Medicare Advantage plans are provided through commercial insurance carriers certified by Medicare.
  • These plans include all Original Medicare’s benefits (Parts A and B), prescription medications, vision, hearing, and dental care.
  • Dental coverage under Medicare Advantage plans can vary widely depending on your chosen plan.
  • Some Medicare Advantage plans may offer more comprehensive dental coverage than Original Medicare, including routine exams, cleanings, and other services.
  • Before enrolling, reviewing each plan’s specific dental benefits, including coverage limitations, copayments, and networks, is essential.

Health Maintenance Organization (HMO) Plans:

  • HMO plans are Medicare Advantage plans that often require members to use a specific set of healthcare providers and facilities.
  • These plans typically have lower out-of-pocket payments and may provide more comprehensive dental coverage than Original Medicare. 
  •  HMO plans usually require members to choose a primary care physician (PCP) and obtain referrals to see specialists, including dentists.
  • Depending on the plan, dental coverage under HMO plans may include preventive care, essential services like fillings and extractions, and possibly more extensive procedures like crowns or bridges.

Considerations for Dental Coverage:

  • When considering Medicare Advantage or HMO plans for dental coverage, it is crucial to review each plan’s network of dentists to ensure your preferred providers are included.
  • Pay attention to any restrictions, such as waiting periods for specific dental procedures or annual maximum benefit limits.
  • Compare premiums, deductibles, copayments, and coinsurance for dental services across different plans to find the best fit for your needs and budget.
  • Remember that while Medicare Advantage and HMO plans may offer more comprehensive dental coverage than Original Medicare, you may still have out-of-pocket costs for certain services.

To conclude

The healthcare system is here to help you in a dental care emergency, but there are different ways to access it. If you’re unsure how to proceed after an injury or illness occurs, call your insurance company for advice. You can also visit a public hospital or an emergency room if necessary.

Remember, if something happens and time is limited, call 911, go straight, an emergency room, or look for a 24 hour dentist. We’ll help you reach them through our directory.

To be connected with a local dentist in your area