What to Know About Medicare and Dental
Article at a glance
In most cases, Medicare does not include dental coverage. However, Medicare beneficiaries can still cover dental services by getting dental insurance from other providers.
Some Medicare Advantage plans may include dental care as an additional benefit.
For those unable to enroll in stand-alone dental insurance, there are other low-cost ways to find dental care.
Oral health is important for overall health, which is why having dental benefits matters. Regularly getting oral exams and other routine dental care and preventive services help keep people, particularly most seniors, in good health. However, do Medicare plans offer dental coverage?
When it comes to Original Medicare, dental services are generally not covered. In fact, the federal Medicare program has excluded dental services from Medicare coverage since 1980, as part of the initial Medicare program.
However, some Medicare Advantage (MA) plans do offer additional health benefits, including those for dental, vision, and hearing. Medicare beneficiaries also have the option to purchase separate dental plans. If you’re looking for information on Medicare dental coverage to better understand how to cover your dental costs, read on below.
Does Medicare Cover Dental Care?
Original Medicare does cover routine dental services. This includes dental services such as dental procedures, dental care, or dental supplies. These include but are not limited to:
- Cleanings
- Fillings
- Tooth extractions
- Dentures
- Dental plates
- Various dental devices
As such, without other forms of health insurance or dental insurance, Medicare beneficiaries can expect to cover the full cost of any dental care that isn’t included in Medicare’s coverage. This means dental care costs can add up rather quickly.
However, Medicare will pay for certain dental services so long as they are directly related to a Medicare-covered procedure. For example, if a patient is in an accident, undergoing inpatient hospital services, and dental work is needed for jaw reconstruction such as dental splints or wiring (covered procedure), Medicare would cover the cost of their dental procedures.
Another example would be tooth extractions to prepare for radiation treatment for neoplastic diseases involving the jaw. However, Medicare will not cover dentures that may be needed after getting teeth pulled.
A third example would be if someone requires a dental or oral examination as part of comprehensive workup prior to an organ transplant surgery, cardiac valve replacement, or Medicare covered dialysis services.
Basically, if someone has a dental infection prior to or alongside a Medicare-covered service and covered conditions would benefit from an oral examination performed by a dentist or treatment to address dental problems, these services might be covered as ancillary services.
2024 Dental Coverage Update
In 2024, Medicare updated their services to cover procedures for any dental or oral complications that stem from radiation, chemotherapy, or surgery related to head and neck cancer. They also will cover dental services and examinations that are necessary before certain procedures related to head or neck cancer.
Note: Learn more about Medicare and dental coverage exemptions at the Center for Medicare and Medicaid Services (CMS). Learn more about the 2024 dental procedure change at this resource.
Do Medicare Advantage Plans Include Dental Insurance?
Medicare Advantage plans, also known as Medicare Part C or MA plans, are offered through private insurance companies that are approved by Medicare. A Medicare Advantage plan will bundle both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
A Medicare Advantage plan may also provide coverage for additional health services, including dental, vision, and hearing. Some MA plans may also include prescription drug coverage, known as Medicare Part D.
Note: Learn more about MA plans and Medicare Advantage enrollment at this resource.
Dental coverage via MA plans is usually quite basic and includes services such as:
Teeth cleaning
Routine X‑rays
Tooth extraction
Fillings
It is important to note that dental insurance, regardless of its origin, will usually have limits on the number of covered services allowed each year, maximum cost allowances, and other stipulations. In addition, different insurance policies may cover different dental services, therefore, enrollees should always check with their provider to receive the most accurate benefit information. Medicare Advantage beneficiaries should always consult with their insurance company to confirm any coverage.
Do Medigap Plans Help With Dental Coverage?
Like Original Medicare, Medigap or MedSupp plans’ covered medical services do not include dental care services. This is because these types of Medicare supplement plans are meant to supplement covered services under Medicare, not uncovered services, such as dental care.
That said, Medicare beneficiaries do not usually need a primary care physician (PCP) referral to access dental care.
How to Pay For Dental Care
Beneficiaries looking to receive dental services can be overwhelmed knowing they are responsible for the cost of their dental care if they don’t have an MA or standalone plan. However, if a Medicare beneficiary does not have dental coverage through an MA plan, there are a number of ways to still be covered for dental or afford dental services such as stand-alone plans, walk-in clinics, and more.
Stand-Alone Dental Plans
Patients can always purchase a separate or stand-alone dental plan for private dental coverage. This may require an additional monthly premium payment.
Walk-in Dental Clinic
Walk-in dental clinics accept clients without dental coverage. These clinics can provide affordable dental care from dental professionals.
Dental School
Dental schools accept clients without dental insurance, and may offer low-cost or free dental care done by medical and dental professionals who are earlier on in their careers.
Contact the State Health Department
Your state health department may have information on how to find low-cost dental services near you.
Health Savings Account (HSA)
Opening an HSA account when you’re below 65 is a great way to save money on dental care and other services since it’s already been set aside.
FAQ
Does Medicare cover emergency or complicated dental procedures that require inpatient care?
Yes, in fact Medicare Part A which is known as Medicare’s hospital insurance will cover inpatient stays required for emergency or complex dental care even though it doesn’t cover routine services. This means Part A will cover services for oral or dental infections and other underlying medical conditions that lead to a hospital stay.
Is it important to find dental and vision care even though Medicare does not cover it?
Dental and vision care are vital to maintaining overall health. It’s important to seek other measures to pay for dental services and vision care including standalone plans, HSAs, or frequenting dental clinics for routine dental or oral examinations.
When does traditional medicare pay for dental services?
Medicare covers dental services that are substantially related and integral to the clinical success of covered treatments. Follow up dental care, dental or oral exams, and medically necessary dental services that aren't associated with other medicare covered services probably won't be covered. For example, a dental ridge reconstruction surgery associated with tumor removal would be covered, but the same jaw surgery wouldn't be covered if not related to a covered medical condition.
