● Medicare FFS typically does not cover dental services directly supporting the teeth, unless the patient requires hospitalization due to an underlying medical condition / clinical status or severity of the dental procedure (1)

● Medicare does cover dental services when they are inextricably linked to the clinical success of other medicare covered services (2)

● Inextricably linked examples include: dental exams prior to certain procedure like organ transplant, cardiac valve replacement, or chemotherapy. Dental ridge reconstruction during tumor removal. Teeth stablization related to jaw fracture reduction. And dental splints for jaw dislocations. (2)

● Dental benefits covered through Medicaid vary by state

● Medi-Cal (California's version of medicaid) can cover dental benefits not covered by Medicare

● For ages 55+, Medi-Cal will pay up to $1,800/year for covered dental services. Some patients may qualify for no yearly limit (3)

● Covered Medi-Cal dental services include: annual exams and cleanings, XR's, fillings, crowns, root canals, dentures, tooth removal, emergency services, and annual fluoride varnish (4)

● A Healthy Smile Never Gets Old! - Helpful Medi-Cal brochure with info on dental coverage and how to find dentist

● Summary - Dental coverage through Medicare FFS is very limited, but dental coverage through Medi-Cal is much more comprehensive

References:

1. Dental services - Your Medicare Coverage

2. Medicare Dental Coverage | CMS

3. Seniors (55+) | Smile California

4. Medi-Cal Dental

Version: GJ 11/30/2024