Dealing with dental issues

[TerrieG95831]

I have major dental issues. I had all of my upper teeth pulled years ago but after I got full time (six days a week), as a rural postal carrier,and a traumatic dental experience when I was a child. Now I have been in so much pain for the last week,ie fever and swelling of the gums . I'm 65 and really think that dental issues should be covered under my health insurance. It is part of my body, and shouldn't be considered as a separate health care problem. Going to call Tele-doc and hopefully get antibiotics at least. Wondering if I am an isolated case 🤔?

[GailL1 · Accepted solution]

Hi, @TerrieG95831, Gail1 here -   DO GET TO A DOCTOR ON YOUR CURRENT PROBLEM so that they can get you some antibiotics.  What you are experiencing is very dangerous to your wellbeing especially since our mouth is so close to our brain.

I heard a person say the other day that Medicare covers you from the neck down - NOT so much with matters of the teeth and gums.

The program of Medicare has very limited dental coverage and it is usually connected to other diseases - they are called "diseases inextricably linked to the dental services".  That does not sound like what you have going on but you should see a doctor or a dentist if for no other reason than to get the infection under control.  

For dental services to be inextricably linked to other Medicare-covered services, different providers (like a doctor and a dentist) must coordinate care to provide:

• Medicare-covered services to treat the illness
• Dental services that are integral to the clinical success of the medical service

Things like an oral exam and treatment of any dental infection before a heart transplant, or reconstructive surgery when an accident or illness has destroyed the jawbone. Or that your teeth were destroyed by massive amounts of radiation given to treat a disease.  Stuff like that only.

Some suggestions for you right now - 

• Go to the ER if you cannot see a dentist or doctor SOON to get those antibiotics especially if it shows signs of getting worse - watch the temp, swelling and pain level.
• See if you qualify for MediCAID to work with your Medicare - some states do cover some dental in their MediCAID programs.  Contact your states MediCAID office.
• Is there a dental school anyplace close to you - sometimes you can get some help there from the students overseen by their teachers.
• there is commercial dental plans out there - but these may have waiting periods before coverage starts, cover may very on what is included and there maybe a network of dentist that you must see for coverage to be effective.  So if you go that route down the road - pick very carefully - read the small print.
• there are some Medicare Advantage plans that have some dental coverage - again the coverage may vary.  But to see what might be available to you in this regards you need to see a local Medicare insurance broker - again pick carefully and read the small print.  
• some dentist may give you a discount for paying cash
• some dentist may offer you terms on payment
• then there is always the ole specific health credit card - be careful here too!

I wish I could help you more but the most important thing at this point is to get that infection under control NOW - do not wait.  See your regular doc if you cannot find a dentist to see you readily - they can prescribe antibiotics and perhaps refer you to a dentist of the type you need for your dental problems.  Medicare MIGHT cover at least that doc visit up to the amount that they pay according to your Medicare plan of choice. Once the infection is under control, then you will have to start the process of getting something else done so that this does not keep occurring.  

Good Luck and hope you get better very soon.  

[SpringIsHereVA]

[Tuesday 6/3/25]

Good Morning Terrie @TerrieG95831 !!!

I hope you will stop by AGAIN to let us know IF you were able to obtain MEDICAID.

Hope so my friend.

Take care,

Nicole  👵  (Healthy Living Forum)

[TerrieG95831]

Pain update...I can deal with it. Not having the throbbing with every heartbeat now. Due to the fact that I am still working i don't qualify for Medicaid, but I do have Medicare. Hopefully since it will require dental surgery my insurance will pay for it due to it being a medical necessity. Thank you for the continued support. Grateful 

[SpringIsHereVA]

Terrie @TerrieG95831 , I hope Medicare will work out my friend. Feel better. Nicole  🤗🤗🤗

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➡️[*** Terrie wrote on Monday 6/9/25:

Pain update...I can deal with it. Not having the throbbing with every heartbeat now. Due to the fact that I am still working i don't qualify for Medicaid, but I do have Medicare. Hopefully since it will require dental surgery my insurance will pay for it due to it being a medical necessity. Thank you for the continued support. Grateful.  ***]

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[GailL1 · Accepted solution]

Hi, @TerrieG95831, Gail1 here -   DO GET TO A DOCTOR ON YOUR CURRENT PROBLEM so that they can get you some antibiotics.  What you are experiencing is very dangerous to your wellbeing especially since our mouth is so close to our brain.

I heard a person say the other day that Medicare covers you from the neck down - NOT so much with matters of the teeth and gums.

The program of Medicare has very limited dental coverage and it is usually connected to other diseases - they are called "diseases inextricably linked to the dental services".  That does not sound like what you have going on but you should see a doctor or a dentist if for no other reason than to get the infection under control.  

For dental services to be inextricably linked to other Medicare-covered services, different providers (like a doctor and a dentist) must coordinate care to provide:

• Medicare-covered services to treat the illness
• Dental services that are integral to the clinical success of the medical service

Things like an oral exam and treatment of any dental infection before a heart transplant, or reconstructive surgery when an accident or illness has destroyed the jawbone. Or that your teeth were destroyed by massive amounts of radiation given to treat a disease.  Stuff like that only.

Some suggestions for you right now - 

• Go to the ER if you cannot see a dentist or doctor SOON to get those antibiotics especially if it shows signs of getting worse - watch the temp, swelling and pain level.
• See if you qualify for MediCAID to work with your Medicare - some states do cover some dental in their MediCAID programs.  Contact your states MediCAID office.
• Is there a dental school anyplace close to you - sometimes you can get some help there from the students overseen by their teachers.
• there is commercial dental plans out there - but these may have waiting periods before coverage starts, cover may very on what is included and there maybe a network of dentist that you must see for coverage to be effective.  So if you go that route down the road - pick very carefully - read the small print.
• there are some Medicare Advantage plans that have some dental coverage - again the coverage may vary.  But to see what might be available to you in this regards you need to see a local Medicare insurance broker - again pick carefully and read the small print.  
• some dentist may give you a discount for paying cash
• some dentist may offer you terms on payment
• then there is always the ole specific health credit card - be careful here too!

I wish I could help you more but the most important thing at this point is to get that infection under control NOW - do not wait.  See your regular doc if you cannot find a dentist to see you readily - they can prescribe antibiotics and perhaps refer you to a dentist of the type you need for your dental problems.  Medicare MIGHT cover at least that doc visit up to the amount that they pay according to your Medicare plan of choice. Once the infection is under control, then you will have to start the process of getting something else done so that this does not keep occurring.  

Good Luck and hope you get better very soon.  

[TerrieG95831]

Can't thank everyone enough. This is amazing. So grateful. Feeling a bit better today. Now fever 🤒 just pain at the gums site. Seriously you are a very kind and knowledgeable person.

[SpringIsHereVA · Accepted solution]

[5/29/25] Terrie @TerrieG95831 , were you able to apply to Medicaid? Take care, Nicole  👵

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➡️[*** Terrie wrote on Thursday 5/29/25:

Can't thank everyone enough. This is amazing. So grateful. Feeling a bit better today. Now fever 🤒 just pain at the gums site. Seriously you are a very kind and knowledgeable person. ***]

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[BtW751689]

Original Medicare does not seem to cover this but supplemental might.  Medicare Advantage--some programs offer dental care though it might be limited.  If you are still with an employer maybe they can help.  You might seek out dental coverage through other programs.  Costco offers it so other membership programs may also.  PS I was told years ago that Medicare covers you from your neck to your knees...

[SpringIsHereVA]

[Wednesday 5/28/25]

Terrie @TerrieG95831 , I am SO SORRY you are having this issue. My Medicare does NOT cover dental, but you can apply for MEDICAID. They cover this for us old folks. Good luck my friend & feel better.  💛  Nicole  👵

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➡️[*** Terrie  wrote on Wednesday 5/38/25:

I have major dental issues. I had all of my upper teeth pulled years ago but after I got full time (six days a week), as a rural postal carrier,and a traumatic dental experience when I was a child. Now I have been in so much pain for the last week,ie fever and swelling of the gums . I'm 65 and really think that dental issues should be covered under my health insurance. It is part of my body, and shouldn't be considered as a separate health care problem. Going to call Tele-doc and hopefully get antibiotics at least. Wondering if I am an isolated case 🤔? ***]

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[papawofboo]

If you see a person named Gail posting anywhere ask her, she knows a lot about Medicare.

[GailL1]

@papawofboo 

Thank you for your vote of confidence.  Yes, I do know a lot about Medicare and Social Security but I am not too sure that I helped @TerrieG95831 too much.  The program of Medicare does not cover most dental problems - Medicare covers only dental services that are inextricably linked to another disease or accident in a way that there is no way to separate or disentangle them.  

[papawofboo]

I was keyed in on what he said happened when he was a child. I know that medica doesn't pay for dental work but it may pay if something else is the cause. 

Where I was thinking I was pretty sure that you would know.

[TerrieG95831]

Thank you for responding. I'm new at this and grateful for advice.