Finding a local dentist that accepts Medicare could be agonizingly tricky or as simple as 1-2-3, depending on the type of supplemental policy you have – if any.
The Centers for Medicare & Medicaid Services (CMS) states that Parts A and B rarely cover dental work except under narrowly defined circumstances when delivered by specific types of providers.
Therefore, seniors with traditional supplemental (Medigap) plans that fill the holes in Parts A and B will have limited choices and might need to identify alternatives.
However, seniors with Advantage plans (Part C) will have more options and a particular place to look because these designs often (not always) include limited dental benefits.
Dentists Accepting Medicare Part C (Advantage)
Finding local dentists that accept your Medicare Advantage (Part C) plan is more fruitful but requires a different strategy. Private insurance companies issue and manage Advantage plans, which cover Parts A, B, and sometimes D – plus comprehensive dental care in many instances.
Each Medicare Advantage plan has a unique network of participating providers. Therefore, seniors should visit the online directory of the issuing company for guidance, as illustrated by several examples.
AARP
Finding local dentists who take an AARP Medicare Advantage plan means visiting the website of United Healthcare (UHC), the insurance company backing this branded affiliate program.
Take advantage of the UHC online dentist finder tool to find a nearby provider participating in your AARP-sponsored plan. Choose the network associated with your specific coverage and narrow your search by specialty.
- Endodontist
- General practitioner
- Oral Surgeon
- Periodontist
- Prosthodontist
Aetna
Identifying dentists who take one of the Aetna Medicare Advantage plans near you also means visiting this insurance company’s website with a slightly different twist. Aetna offers two designs that impact your choice of providers.
- Network plans cover preventive care 100% (exams, cleanings, X-rays) and sometimes comprehensive services such as fillings and extractions. However, you can only choose participating providers.
- Direct Member Reimbursement (DMR) plans allow you to see any provider that has not opted out of the program and cover preventive and comprehensive services.
Visit the Aetna Medicare website and follow the “Find a Doctor, Dentist, or Hospital” link for their online directory of participating providers.
BCBS
Locating nearby dentists that take a Blue Cross Blue Shield (BCBS) Medicare Advantage plan includes another twist. BCBS is not a single enterprise. Instead, it is a national federation of thirty-seven independently owned and operated insurance companies.
Each BCBS affiliate makes business decisions and operates in states with different regulatory environments. Therefore, seniors do not have a one-stop resource.
Begin at the national BCBS Medicare website if you are unsure of the affiliate name. Enter your zip code into the form, and the site will redirect you to the appropriate entity.
Better yet, look at your BCBS member ID card for precise information.
Humana
Finding par dentists that take the Humana Medicare Advantage plan is relatively straightforward –pull your member ID card out of your wallet or purse and have two bits of information handy.
- The Member ID number printed on the card
- Your date of birth
Humana offers four Medicare Advantage Plan designs, as do other private insurance companies serving the senior marketplace. Each version could have a unique provider network, and you want accurate results.
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNP)
The Humana Find a Dentist search tool provides the most reliable answers when you input your member ID and date of birth or log in to their online customer portal first.
Dentists Accepting Medicare Parts A or B
Identifying local dentists that accept Medicare Parts A or B is only half the battle because CMS rules explicitly exclude “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.” [1]
Financial assistance programs and dental charities might prove more helpful because getting treatment from a participating provider offers little benefit when coverage does not honor claims for the services you need.
However, seniors can find limited exceptions when the care is an “integral part of a covered procedure” and should verify the Medicare status of the provider before receiving treatment.
- Accepts assignment: charges only the approved amount
- Rejects assignment: bills up to 15% above the approved amount
- Opted out: receives no Medicare reimbursement except in emergencies
Emergency Dentists
Finding an emergency dentist in your neighborhood that takes Medicare Part A or B is the easiest because the pool of eligible providers expands when you urgently need immediate oral care. Plus, the program pays for select services.
- Typically, Medicare does not pay claims for covered services to providers who opt out of the program. However, CMS suspends this rule during emergencies, meaning you can choose any dentist with immediate availability. [2]
- Parts A and B sometimes pay for emergency oral care when the treatment is integral to a covered procedure, as these opposite examples illustrate.
- Qualifies: A senior citizen falls, breaking several teeth that need immediate treatment to relieve pain, stop bleeding, and prevent infection
- Ineligible: A senior needs immediate treatment for a root canal or severe toothache associated with caries or gingivitis
In the accident instance, Parts A or B might pay for the initial urgent care only (no follow-up treatment) – regardless of the provider status. Therefore, a simple query via a search engine of emergency dentists near you will suffice.
Oral Surgeons
Seniors can also easily find a list of local oral surgeons who take Medicare Part A or B because a broader array of procedures might be an integral part of a covered service, and you can use the online provider directory.
CMS explicitly states that they honor claims for two procedures frequently performed by oral surgeons.
- Reconstruction of the jaw following an accidental injury
- Tooth extractions in preparation for radiation treatment due to cancer
Other procedures performed by oral surgeons fall into a gray area because CMS does not explicitly state that they will honor claims. Therefore, you will have to build a case with help from the provider.
- Mandibulectomy to remove cysts and cancerous tumors
- Temporomandibular joint disorders (TMJ)
- Operations to treat obstructive sleep apnea
Use the Medicare.gov online provider directory to create a list of participating oral surgeons, giving preference to those who accept assignment.
Oral Exams
Seniors can sometimes find dental offices or clinics that take Medicare Parts A or B for comprehensive oral exams (perhaps including X-rays) but never treatment. You might utilize two different resources to identify participating providers in these cases.
CMS explicitly states that it pays for comprehensive examinations but not treatment when connected with two covered procedures and when performed in specific facilities.
- Before heart valve replacement at a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC), use the Health Resources & Services Administration online directory to find an RHC or FQHC in your area.
- Before renal transplant surgery in an in-patient hospital, utilize the Medicare.gov online provider directory, selecting a dentist affiliated with the hospital where you are staying.
Pediatric Dentists
Finding a local pediatric dentist that takes Medicare Parts A or B should prove elusive even when the treatment is integral to a covered service. The two terms typically do not belong together in the same sentence.
- Pedodontists specialize in treating kids up to age 21
- Medicare rarely covers children and focuses on other groups
- Seniors age 65 and older
- People with a disability who worked in the past
- Patients with specific health disorders
- End-stage renal disease
- Amyotrophic lateral sclerosis (ALS)
In other words, pedodontists have no reason to accept Medicare assignment because their youthful patients lack coverage. Perhaps you made a common typo and meant Medicaid instead.
Pediatric dentists taking Medicaid are far more common because this government-sponsored coverage for low-income families includes oral care for children in all fifty states.
Tooth Implants
Senior citizens must apply the lessons addressed above (Part A & B) and below (Part C – Advantage plans) when looking for nearby dentists taking Medicare for tooth implants.
- Medicare does not cover dental implants (replacement of missing teeth)
- Extractions qualify for reimbursement under specific circumstances
- After accidental injury
- Before radiation treatment for cancer
- Advantage Plans might cover more steps with low annual maximums
- X-rays
- Endodontic services
- Prosthodontic services
Article Citations:
[1] CMS Dental Coverage Guidelines
[2] Medicare.gov Lower Costs with Assignment
