Medicare Will Now Cover Medically Necessary Dental Care
Entrusted Legacy Law
Dec 09, 2022
Pennsylvania - Greater Pittsburgh Area
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In November 2022, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare coverage will be expanded to include medically necessary dental services. This change in Medicare rules will allow people with life-threatening conditions to receive dental care and operations related to conditions approved by CMS.
The provisions in the final rule become effective on January 1, 2023.
What Makes Dental Care Medically Necessary?
The final rule expanded the definition of “medically necessary.” Medicaid currently defines “medically necessary” as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
When it goes into effect, the final rule will include dental care in the definition of medically necessary care.
The final rule also expanded the definition of “physician” to include dentists and oral surgeons.
What Dental Care Is Included in the Final Rule?
The types of dental care and procedures covered will be limited to patients who:
1. Have a jaw fracture and need their teeth stabilized or immobilized.
2. Need a tumor surgically removed, and ridge reconstruction must be performed to remove the tumor.
3. Have a neoplastic disease, and teeth extraction is necessary to prepare the jaw for radiation.
4. Have certain heart diseases and need to receive examinations and treatment before receiving cardiac valve replacement, organ transplant procedures, or valvuloplasty.
5. Need dental splints (only if they get this treatment in connection with a medically necessary treatment).
In addition to the above services, Medicare coverage will be applied to other necessary medical care, including:
- Anesthesia
- X-rays
- The use of an operating room to perform dental services
Expanded Dental Coverage Does Not Apply to Patients With Diabetes
Neither the final rule nor the interim rule expanded dental coverage for diabetes patients. The final rule does not cover normal dental examinations for diabetic patients, despite the importance of regular dental checkups for this population. However, coverage could expand over the next several years.
The Effect of Having Dental Coverage on Medicare Recipients
The expansion of Medicare dental coverage will have a positive impact on some seniors, while others will not receive any benefit. Because of the language included in the final rule, some seniors will receive savings for dental care if dental work is required to treat qualifying medical conditions. Seniors who do not qualify for the expanded dental care coverage in the final rule are still required to pay a fee for services not covered by Medicare.
Patients with diabetes can expect to continue to pay for dental examinations and surgeries out-of-pocket if Medicare does not cover the procedure.
The Future of Expanded Coverage for Medicare Recipients
Seniors enrolled in Medicare can expect more changes to coverage in the future. CMS announced its intention to complete an annual review of covered services, as well as possibly expand the definition of “medically necessary” and include more services for dental care.
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Elder Law 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086Our Firm Prepares You for Life What makes our firm different is that we were built with the needs of growing families in mind. We understand you are BUSY, you are growing, you are planning for a life of prosperity and you value ease, convenience and efficiency. You are raising children, and caring for elderly parents, while also working hard to build your own nest egg for a lifetime of support. You want to know youve made the best decisions for your family and that your plan will work when your loved ones need it most. You want to make sure your minor children would be raised by the people you choose, and never by anyone you wouldnt want, and that your teens and adult children are properly prepared to care for you and what you leave behind. You want to feel confident that youve made the right choices, and handled everything so that you arent leaving behind a mess, when something happens. That is our focus as well. Weve developed unique systems to give you the same access to a Personal Family Lawyer as was previously only available to the super-wealthy, so you can have the guidance you need to build and maintain a life of prosperity and wealth. And, to keep your family out of court and out of conflict, which is the greatest risk to the people you love and all you have created, even if youve already worked with a traditional lawyer or created documents online. Our Team Is Here for You We encourage communication with our clients. In fact, weve thrown out the time clocks so you never have to be afraid to call with a quick question. Everything we do is billed on a flat-fee basis, agreed to in advance, so there are never any surprises. We have a whole team to serve you. When you call our office to ask your quick question, you wont have to wait hours or days for a phone call back. Youll get your question answered, right away. And, if you need to schedule a more in-depth legal or strategic call with your Personal Family Lawyer, a call will be scheduled when you're both available and ready for the call so we can make the very best use of your time and not waste your time by leaving voicemail after voicemail back and forth. And, we ensure the most important details of your planning are followed through on and your plan continues to work throughout your lifetime. We have a funding coordinator to ensure your assets are owned the right way throughout your lifetime and none of your assets will end up going through a long, expensive court process or being lost to the state because they were missed after your death. Weve created unique membership programs to keep your plan up to date year in and year out as well as give you access to our Trusted Team of Legal Experts for guidance on ANY legal or financial matter. One day you will need a lawyer. I dont know why and I dont know when, but when you do, you will be grateful you can call on us and well be here to advise you or get you out of a jam. We Help You Transfer Your Life and Legacy Lastly, we believe your financial wealth is only a small part of your overall Life and Legacy Planning which is made up of your far more valuable and most often lost upon incapacity or death intellectual, spiritual and human assets. These assets are what make you who you are, and sum up whats most important to you. And, a survey of inheritors has revealed that what they care about even more than inheriting your money, is inheriting these intangible assets. Most estate plans only focus on the transfer of your financial wealth to the next generation. Most people have such great intentions of passing on the intangible, but very few ever get around to it. Its just not a priority, until its too late. How much do you know about your grandparents values? Their most prized personal possessions? How they felt about you? What they had learned during their lifetime? If you are like most people, you know very little. Thats why we build the capture and passage of these most valuable assets into every estate plan we create. Not only will we help you pass on your money, but also your values, your insights, your stories and your experience the truly valuable assets your loved ones care about the most. Weve developed a tool that allows us to capture and pass on your whole family wealth, including your Intellectual, Spiritual and Human assets. I cant go into all of the details here, but well definitely talk about it when you come in for your Life and Legacy Planning Session.