What is Medicare?
Medicare is a federal health insurance program specifically designed for people who are 65+ years old, people below 65 with disabilities, and people who have end-stage renal disease (ESRD). ESRD refers to permanent kidney failure that requires dialysis or a transplant.
Medicare has two types: Original Medicare and Medicare Advantage, with plans open for general enrollment. In this article, we will be talking about Original Medicare.
While Medicare covers most hospital costs, outpatient visits, and costs of prescription drugs, this insurance does not cover several services such as long-term care, eye exams, cosmetic surgery, massage therapy, routine physical exams, hearing aids, etc.
Everything that Medicare covers is in 3 parts: part A, part B, and part D.
What is Medicare Part A?
Medicare Part A refers to hospital insurance. Part A covers inpatient hospital stays, hospice care, care in nursing facilities, and some home health care services.
What is Medicare Part B?
Part B of Medicare includes medical coverage. It covers certain doctors' services, outpatient care, preventative services, and medical supplies.
What is Medicare Part D?
Medicare Part D is prescription drug coverage. This part of Medicare helps cover the cost of prescription drugs, including many recommended shots or vaccines.
Types of dental services
Dentists are healthcare professionals who treat various conditions affecting teeth, gums, jaws, and other mouth areas. Dental services offered by these medical professionals can be broadly categorized into three parts:
- Preventive Dentistry: These services are provided by dentists to protect one's teeth and gums from disease-causing bacteria, thus stopping issues before they even begin. Preventive dentistry includes services like dental exams, dental x-rays, cleanings, sealants, fluoride treatments etc.
- Restorative Dentistry: Restorative dentistry includes procedures to repair or replace damaged/missing teeth. These treatments can consist of restorative treatments such as fillings, crowns, bridges, dental implants, etc.
- Emergency Dental Care: Several dentists offer 24/7 emergency dental services such as tooth extractions, treating knocked-out teeth, root canals, etc.
Does Medicare cover dental services?
Unfortunately, in most cases, Medicare does not cover dental services. Medicare generally does not cover preventive, restorative, or emergency dental services. Thus, routine cleanings, fillings, tooth extractions, or items like dentures are not covered by Medicare.
However, in certain specific cases, Medicare may cover dental services as well:
- Certain dental services that a patient may receive while they're admitted as a hospital inpatient may be covered. These services might be due to the patient's underlying medical conditions or because of the severity of the procedure.
- Medicare covers specific inpatient or outpatient dental services directly related to certain covered medical treatments. In these cases, the patient must get the dental service because it's linked to the success of their medical treatment. Examples of such situations include an oral exam and dental treatment before a heart valve replacement surgery or a dental procedure to treat a mouth infection before getting cancer treatment.
Medicare vs Medicaid
Often, people confuse Medicare with Medicaid. After all, they are both government health insurance. Thus, the confusion is valid. However, Medicare and Medicaid are very different things.
While Medicare is a federal health insurance specifically for people 65 or older and some young people with certain disabilities or conditions, Medicaid is a joint federal and state insurance program that helps cover medical costs for people of all ages with limited income and resources.
As Medicare is a federal program, the eligibility rules remain the same across geographical areas. However, while the federal government has laid out certain rules for Medicaid, each state runs its own programs. This means that the eligibility and benefits of Medicaid vary from state to state.
Medicaid usually covers services that Medicare does not, such as personal care services, nursing home services, etc.
People with Medicaid usually are not required to pay for covered medical expenses but may owe a small co-payment for some items or services. On the other hand, members of Medicare pay part of the costs through monthly premiums for medical and drug coverage, deductibles, and coinsurance. If this insurance lingo seems complicated to you, worry not! Zocdoc's Health Insurance 101 has got you covered!
Medicare dental coverage
Approximately 65,748,297 Americans are enrolled in Medicare as of March 2023, as reported by The Centers for Medicare & Medicaid Services (CMS). Of the total people enrolled in Medicare, around 33,948,778 are enrolled in Original Medicare, while nearly 31,799,519 are enrolled in Medicare Advantage (plans open for general enrollment) or other health plans.
However, based on 2019 data from KFF, nearly 47% of Medicare beneficiaries did not have dental coverage. Only about 29% of people had access to dental coverage through Medicare Advantage plans.
While original Medicare does not cover most dental services, Medicare Advantage plans do cover these. KFF reported that in 2021, nearly 16.6 million, or 94% of Medicare Advantage enrollees in individual plans, had some dental coverage.
If you are among the people who have Medicare dental coverage, then hop onto Zocdoc to find the best dentists that accept Medicare near you!
Find top dentists that accept Medicare near you
If you have Medicare and are curious about which dentists near you will accept your insurance, then Zocdoc is the place for you!
Zocdoc's insurance checker lets you upload a photo of your Medicare insurance card to give you not only the dentists in your area who will accept your plan but also give you an estimated copay amount. If you don't want to share your insurance card, you can always select your plan from the drop-down insurance menu. This will give you a list of all the dentists near you, along with the ratings, reviews, bios, location, available slots, and whether or not they take virtual appointments. The bios of all dentists include everything you would like to know about your provider, such as their education, accolades, memberships, hospital affiliations, languages spoken, gender, etc.
Once you shortlist the top dentists that accept Medicare near you, all you have to do is give your basic details and book the appointment. All appointments through Zocdoc are simple, secure, and 100% free!
Sources
Medicare.gov[1]
Medicare.gov[2]
U.S Department of Health and Human Services
KFF[1]
KFF[2]
Center for Medicare Advocacy
Cleveland Clinic
