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Dental and Medicare

Medicare covers very few services, but regular checkups are essential.

Perhaps it has been a while since visiting the dentist?

The American Dental Association recommends that all adults over age 60 get a least an annual dental exam, even if they do not have tooth pain or other obvious problems.

Since nerves shrink and become sensitive with age, it may be too late to save a tooth by the time a person feels discomfort. It is also possible to have problems typically associated with youth, such as a painful wisdom tooth.

Preventative treatment is certainly more affordable than waiting for a costly root canal or surgery. Some dental problems can even cause health issues to become worse. Poor dental habits can lead to the tooth and gum disease linked to heart disease, pneumonia, arterial blockage, and stroke.

Still, many older adults avoid visiting their dentist due to cost. In 2010, one in five Medicare recipients had not seen a dentist in the last five years, according to the Kaiser Family Foundation.

The Limits of Medicare for Dental Care

Unfortunately, the most commonly needed dental treatments are not covered by Medicare.

"These include cleanings, x-rays, plates and the things we see our dentist for during a regular exam," says Jonathan Burlison, outreach director at Nebraska SHIIP (Senior Health Insurance Information Program).

Some exceptions exist: Medicare Part A might pay for some or all of an emergency hospital visit where a complicated dental procedure would be necessary, he says.

Most patients, however, will not need the very specific procedures that are covered, such as exams completed in preparation for a heart valve replacement or cleanings prior to oral cancer radiation, according to the Centers for Medicare and Medicaid services.

In the case of an accident or injury that forces a patient to receive dental work in the hospital, it is possible to receive some help from Medicare for just the immediate care while in the emergency room or as an in-patient. Follow-up care after leaving the hospital, however, is not usually Medicare-eligible.

How Older Dental Patients Pay

Given that a person really cannot rely on Medicare to foot the bill, how are most patients over age 65 handling dental expenses?

A 2016 Medicare beneficiary survey revealed that 75 percent of dental costs are paid out-of-pocket by patients, leaving many people on a fixed income to cover the average cost of $929 per year without any financial help. Employer-based plans paid 12 percent of costs, and Medicare Part C paid 4 percent. Medicaid paid less than 1 percent of patient costs.

Ernie Bobel, Jr., an independent insurance broker, of EHB Insurance Group, recommends that older patients look into reasonably priced individual dental plans, either as a rider to their existing private health plan policy or a stand-alone plan.

Mr. Bobel also suggests that those looking to receive help paying for dental procedures begin researching their options well in advance of Medicare open enrollment so they are prepared when it is time to choose plans.

"While no dental plan usually covers everything, even the most reasonably priced options will help with the cost of one or two cleanings per year with a discount for major dental work, such as a root canal or crown," he says.

These coverages are similar to the dental plans younger patients purchase through their employer or as an add-on rider to their private individual policy.

Consequences of No Dental Care

With the cost of dental care rising as we age, it is not surprising that many Medicare patients just skip the annual cleaning. Half of Medicare survey respondents admitted that a strained budget is the reason for dismissing regular visits to a dental professional.

This may be the reason behind a Kaiser Family Foundation report that states one in four Medicare beneficiaries had edentulism (lacking natural teeth).

It also underscores the importance of educating older Americans regarding the role that Medicare plays, or rather, does not play, in maintaining healthy teeth and gums, and why alternatives must be sought before costly ailments occur.

Dr. Jason Cabler, a Fairview, Tennessee dentist, recommends that even patients with supplemental insurance check to make sure they know exactly what is covered so they are not surprised when they arrive at the dental office for treatment. It may be possible for patients with no coverage to devise a payment plan or other financial arrangements with the provider in advance of treatment.