Access to basic dental services is not just about a healthy smile. It’s also crucial for overall well-being and improved quality of life, particularly for older adults and individuals facing financial constraints.

While Medicare and Medicaid are well-known healthcare programs, understanding their dental care coverage differences can be complicated. Let’s dive into the details of Medicare vs Medicaid. We will highlight how each program addresses dental care and dentures, who is eligible, and what you can expect with a Medicare dentist.

Medicare or Medicaid sign

Understanding Medicare and Basic Dental Services

Medicare, the federal health insurance program primarily catering to individuals aged 65 and older and those with disabilities. Medicare offers coverage for a broad spectrum of medical services. However, it is important to note that most routine dental care falls outside the coverage provided by Original Medicare.

Original Medicare may cover some dental services closely tied to other covered medical treatments. Receiving comprehensive dental coverage often requires enrolling in a Medicare Advantage plan, also known as Medicare Part C.

These plans are approved by Medicare and provide a more tailored approach to healthcare. They incorporate benefits beyond what Original Medicare offers, such as dental, vision, hearing, and prescription drug coverage.

Under a Medicare Advantage plan, beneficiaries can access a range of dental services, including:

1. Preventive Dental Services: Routine checkups, routine cleanings, and early intervention to maintain oral health.

2. Basic Dental Services: Fillings, extractions, and root canals that address common dental issues.

3. Major Dental Services: Crowns, bridges, and dentures, which play a pivotal role in restoring dental functionality.

There may be deductibles, copayments, or coinsurance associated with certain services. Additionally, some services or items may have coverage limitations or require prior authorization.

Understanding Medicaid and Basic Dental Services

Medicaid is a state and federally funded program. It is designed to provide healthcare coverage to individuals with limited financial resources. However, specific Medicaid coverage, including dental services, can vary from state to state.

In Missouri, Medicaid is known as MO HealthNet. MO HealthNet extends coverage to a variety of groups, including:

           • Adults under 65 with household income up to 138% of the poverty level.

           • Children up to age 18 with household income up to 155% of the poverty level.

           • Pregnant women with household income not exceeding 201% of the poverty level.

           • People with disabilities.

MO HealthNet offers coverage for dental services, including:

1. Preventive Dental Services: Routine checkups, routine cleanings, and x-rays.

2. Basic Dental Services: Fillings and extractions.

It is important to be aware that major dental services like dentures, partial dentures, or snap-in dentures are not typically covered under MO HealthNet.

However, enrolling in a managed care or fee-for-service program could expand the range of covered services. Research into these options could help uncover a more comprehensive plan that is best for your needs.

senior couple looking over policies

Take Charge of Your Healthy Smile – It’s Essential

Maintaining good oral health is a crucial aspect of overall well-being and quality of life. This is especially true for older adults and those facing financial constraints.

Gaining a clear understanding of the extent of dental coverage provided by Medicare and Medicaid is essential for making informed decisions about your healthcare needs.

Here at Access Dental, we recognize the universal significance of dental care. If you find yourself unsure about the Medicare dental services you qualify for, don’t hesitate to reach out to us.

We are dedicated to helping you comprehend the care options available to you, ensuring that you receive the necessary services to maintain your oral health. Your healthy smile matters to us! Contact Access Dental today at 1-877-DENTIST to ensure you are making the most of your eligible dental care services. And to maintain the well-being of your oral health for years to come.