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The Tooth and Nothing but the Tooth

Recently I had some major dental work done. It’s like repairing the plumbing in your house – it’s expensive to do, you have to fix it, and the end product is really no better than when it was originally installed. After all the time and expense, your teeth are merely functional – not improved on the original – just operating like they should.

This is not to disparage dentists – I have a great dentist. We need these folks to fix our teeth, especially as we age. I am reminded of those sad, old photographs of the elderly who have had all their teeth pulled. Nothing but liquids and mush for them. What would President George Washington have looked like without his wooden false teeth?

Dental health is the most overlooked aspect of health maintenance as we age. The elderly make it to the doctor, but not so much to the dentist. Good dental maintenance can spot infection problems early, and improve function and appearance.

Medicare doesn’t cover routine dental work. You have to purchase a separate policy, and even those don’t cover more than half the cost of major work. Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have a teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures.

Some Medicare Advantage plans cover routine dental services. If you have a Medicare Advantage plan, check with your plan to see what dental services may be covered. However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare covers to be successful.

Medicare will pay for dental services if, for example:

  • you receive an oral examination in the hospital because you will be having a kidney transplant or in a rural or federally qualified health clinic before a heart valve replacement;
  • you have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
  • you had a facial tumor removed and had ridge reconstruction (reconstruction of part of the jaw) as part of that procedure;
  • you need surgery to treat fractures of the jaw or face;
  • you need dental splints and wiring as a result of jaw surgery.

While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated. For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.

Medicare will pay for some dental-related hospitalizations, for example if you:

  • develop an infection after having a tooth pulled;
  • require observation during a dental procedure because you have a health-threatening condition.

Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.

If Medicare doesn’t cover the expense, then most elderly can’t afford it out-of-pocket. Other healthcare costs often take precedence. Then there’s rent and food.

So, if I sound like sour grapes about having major dental work done, it was the right thing to do and a wise use of my money. I do, however, grit my teeth as I pay the bill.