Effective January 1, 2023 Medicare coverage is expanded to include “medically necessary dental service.” This change allows people with life-threatening conditions to receive dental care and operations related to conditions approved by CMS.
The key to understanding who qualifies is to understand the definition of Medically necessary.
The types of dental care and procedures that will be covered are:
- A jaw fracture and teeth need to be stabilized or immobilized.
- Need a tumor surgically removed, and ridge reconstruction must be performed to remove the tumor.
- Have a neoplastic disease, and teeth extraction is necessary to prepare the jaw for radiation.
- Have certain heart diseases and need to receive examinations and treatment before receiving cardiac valve replacement, organ transplant procedures, or valvuloplasty.
- Need dental splints (but only if they get this with a medically necessary treatment.)
In addition to the above, Medicare coverage will be applied ot additional necessary medical care, including:
- The use of an operating room to perform dental services.
It is important to know that this coverage does not expand to normal dental examinations for diabetic patients. This is unfortunate in that this group should have regular check-ups. Patients with diabetes will have to continue to pay for dental examinations and surgeries out-of-pocket, if these services are not covered by Medicare. We will keep an eye out for future developments in this area.
Bottom line: This expansion is a positive move for some, but not all seniors. If the dental work is required to treat qualifying medical conditions those seniors will receive savings for dental care. Seniors who do not have these qualifications will still pay a fee for services not coverd by Medicare.