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Dr. Gordon is a Medicare Provider and a Medical PPO Provider for Medically Necessary Procedures

Medicare Coverage and Dental Benefits

How We Can Help?

Medicare does not cover most basic dental procedures, like cleanings, fillings, tooth extractions, or dentures. However, Medicare Part B has coverage for some dental surgical procedures, and we may be able to help you. Such as removal of infection or cyst along with bone grafting and biopsies if needed.

We Can File Medical Claims for Medically Necessary Procedures

Such as Accidents or Injuries to the mouth, teeth, or jaw under your medical plan.

Examples:

  • If you had an accident (car accident, fight, fall, etc.) early on in your life that broke your jaw that affected your teeth, most of the time, your medical insurance may cover claims way down the road if a tooth or two should happen to fail as a result of the accident.
  • If you had any tumors/cancer in your face or sinus’ as a child and had chemotherapy and are now losing teeth as an adult, your medical insurance may pay to replace these teeth later on in life.
  • If you had major orthodontics and had jaw reconstruction an are now losing teeth; your medical insurance may cover to replace teeth.

With all medical claims, we must do a Pre-Authorization, and your Medical Deductible has to be met before they will pay. If Dr. Gordon is considered OUT OF NETWORK, they will recommend you find a dentist IN-NETWORK. However, most general dentists do not file Medical claims, and there is a Medical GAP Exclusion that can be filed.

Dr. Gordon is a Medicare Provider and a Medical PPO Provider for Medically Necessary Procedures

Our treatment coordinator can go over your Medicare coverages with you. Click Here To Contact Us!

Medically Necessary as Defined by Medicare Advantage

Medically necessary is defined as a treatment or service that is required in order to treat a specific injury, illness, disease or condition.

  • For example, if you suffer an injury that results in facial or jaw fractures and are admitted as a hospital inpatient, Medicare Part A may cover some of the costs of your hospitalization and surgery costs.
  • If your oral surgery is performed in an outpatient setting, Medicare Part B may cover the surgery if it is medically necessary and is part of a Medicare-covered service.

It is important to keep in mind that Medicare will not cover oral surgery that is solely intended to treat your teeth, such as the installation of bridges, crowns, or dentures.

If you require this type of surgery, you will likely pay the full cost of your treatment unless you have dental insurance or a Medicare Advantage (Medicare Part C) plan that offers dental benefits.”

How To See If You Qualify

Often if you have an infection in the jaw, Medicare will pay for the process to remove the infection and have a bone stabilizer placed. The bone stabilizer is the “dental Implant.” A dental Implant is three parts; the next two parts, the abutment and the crown, are covered by the patient or the patient’s supplemental insurance.

To get an idea of cost, you must come in for new patient consultation, including a CBCT scan (x-ray), to see if you qualify and determine your portion. Dr. Gordon will often discount this part of the treatment.

Please note We cannot offer a FREE consultation to Medicare patients. Medicare will be billed for your visit. As long as your $198 yearly deductible has been met, your visit should not cost you anything.

Schedule Your New Patient Consultation Today!