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You may already know that Original Medicare does not cover most dental services. However, in certain situations, it’s possible to get Medicare to provide coverage for some issues that affect your mouth and gums.
If you or a loved one is suffering from gum disease, you may wonder if that is one of those situations Medicare offers some coverage. This is why many people have a very common question: “Does Medicare cover Periodontal Disease?” In this article, we answer the question in clear, plain English.
You will also find the average treatment costs for periodontal disease for those who don’t get insurance coverage.
Does Medicare Cover Periodontal Disease?
The short answer is no. In most cases, Medicare will not cover the cost of treatment for periodontal disease. That being said, there may be some rare situations where you can get these costs covered.
Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your treatment for periodontal disease.
Original Medicare Coverage of Periodontal Disease
Original Medicare (Medicare Part A and Part B) does not provide coverage for treatment for periodontal disease. So that means you will have to pay 100 percent of your treatment for periodontal disease.
Original Medicare does not provide coverage for most types of gum, teeth, and overall oral health treatments and services.
In some cases, you may receive coverage for your dental health treatment, mainly when it is medically necessary to treat another condition.
When Might Part A Provide Coverage of Periodontal Disease?
Medicare Part A may provide coverage for treatment for periodontal disease or some other routine dental procedure if it is part of a/an:
- Emergency oral surgery
- Certain complicated dental procedures
- Dental care prior to, or as part of, a medically necessary procedure
Medicare Part A will provide coverage if any of these take place in an inpatient facility such as a hospital.
When Might Part B Provide Coverage of Periodontal Disease?
On the other hand, Medicare Part B would provide coverage for treatment for periodontal disease if it takes place in an outpatient setting.
Medicare Advantage Coverage of Periodontal Disease
If you have a Medicare Advantage (Part C) plan, that plan may provide treatment for periodontal disease coverage.
Medicare Advantage plans cover all the same things that Original Medicare covers. But they also provide coverage for some things that Original Medicare does not. Often this includes dental coverage.
In fact, quite a few Medicare Part C plans provide coverage for dental care. So if you have one of these plans, you’ll likely get at least some coverage to treat periodontal disease.
However, exactly what is covered and how much you’ll have to pay for that coverage will vary from plan to plan. So, if you have a Part C plan, be sure to check with your provider to see if you have dental coverage and if that includes treatment for periodontal disease.
Periodontal Disease Treatment Costs
The best treatment options for periodontal disease can typically cost between $1,700 – $8,000. The first option most doctors and dentists use is root scaling and planning. But more advanced treatments, such as laser treatment, are also available. Additionally, teeth extractions may be necessary. These average $200.00-$300.00 per tooth.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Non-FDA Approved Drugs?