• Does Medicare Pay For Dentures

Does Medicare Pay For Dentures ?

Medicare provides coverage for dental services that form an integral part of a covered procedure.

Currently, they do not provide coverage for routine dental care, preventive dental care or dental procedures like cleanings, fillings, tooth extractions or dentures. Medicare does not provide coverage for dental plates or other dental devices either.The Section 1862 (a)(12) of the Social Security Act states that Medicare will not provide coverage for dental care where expenses are related to services like care, treatment, filling, removal, or replacement of teeth or structures that support the teeth. However, coverage will be extended as part of Medicare Part A if the patient requires inpatient treatment of his or her underlying health or medical condition, or because of the seriousness of the dental procedure.

Initial Medicare program excludes the coverage of dental services. The following categories of services are excluded from Part B coverage:

• A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw, regardless of the complexity or cause.
• A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition (e.g., tumor removal) and it is performed at the same time as the covered primary service and by the same physician/dentist.

In cases in which the above mentioned criteria are met and coverage has been provided on  secondary services, Medicare does not pay for the cost of dental appliances, such as dentures, even though the covered service required the replacement of the teeth. Also, it does not pay for the cost of preparing the mouth for dentures or the cost of directly repairing teeth or structures directly supporting teeth.

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