Does Medicare Cover Dental Care?
Learn what the coverage options are for routine dental care.
Does Medicare Cover Dental Care?
Generally, no, Medicare does not cover dental care. It is possible that your Part A coverage (Original Medicare) pays for inpatient hospital care in the event of an emergency or if you require a complicated dental procedure while you’re in the hospital.
However, Original Medicare does not cover most dental care. This includes all routine dental procedures, cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
For any of these dental procedures, you are responsible for 100% of the costs unless you are otherwise covered by an additional insurance policy.
Scenarios In Which Medicare May Cover Dental
As mentioned earlier, there may be a few scenarios in which your Part A coverage, also known as your hospital insurance, will cover a dental procedure.
Generally, these are scenarios that involve a Part A covered procedure in which dental services are required to precede, prepare, or be part of the procedure.
Here are a few scenarios to give you a sense of when Medicare may cover dental services:
If you have a neoplastic disease involving your jaw and a tooth extraction is required in preparation for your radiation treatment.
If you have suffered an accidental jaw injury and dental services are an essential part of your jaw reconstruction (a covered procedure).
If you are undergoing kidney transplantation or heart valve replacement, Medicare may cover an oral examination (not treatment) preceding your procedure.
If your underlying medical condition requires inpatient hospital care or the severity of your dental procedure requires hospitalization.
Senior Dental Coverage Options
If you are a senior on Medicare looking for routine dental care coverage, you will need to explore some different options outside of Original Medicare coverage.
Here are 3 different options available to you:
1. Medicare Advantage Plan
It will depend on the plan, but many Medicare Advantage plans offer benefits not covered by Original Medicare. These extra benefits include dental, vision, hearing, and wellness programs.
Medicare Advantage dental benefits can cover what are considered preventive services, regular services, and major services.
Preventive services include cleanings and exams. Regular services include X-rays, fillings, and extractions. Major services include crowns and root canals.
Keep in mind, however, that these dental categories are not comprehensive and your own dental coverage will depend on your specific plan.
Some Medicare Advantage plans may only provide preventive dental coverage, whereas other plans may provide comprehensive dental coverage.
Note: While Medicare Advantage plans can offer routine dental coverage, Medicare Supplement plans (Medigap) do not offer routine dental coverage.
Medigap plans only supplement the coverage offered by Original Medicare.
2. Stand-Alone Dental Insurance Plan
While there are a limited number of options to receive routine dental coverage through Medicare, there is always the option to purchase a stand-alone dental insurance plan.
With a stand-alone dental plan, you will make a monthly premium payment and see a dentist that is part of your plan’s network (just as with any insurance plan).
3. Discount Dental Plan
You also have the option to sign up for a discount dental plan. This option works a bit differently from that of an insurance plan (so, no copays or premiums).
The discount dental plan requires a membership fee, which is typically less expensive than an insurance plan. Your membership then entitles you to discounted rates at certain dentists.
This rate is typically between 25% and 50% and then you are responsible for the remaining balance.
Check Your State’s Medicaid Program
Also worth noting is that some individuals may be eligible for their state Medicaid program.
However, whether or not your state’s program includes the coverage for dental services will depend on the state you live in.
Visit Medicaid’s Dental Care page to learn which benefits may be available to you.
Switching Medicare Plans to Receive Dental Care
If you are interested in switching from Original Medicare coverage to a Medicare Advantage Plan that includes dental coverage, you can do so during the Medicare Open Enrollment Period.
This period runs each year from October 15 to December 7. Learn more about the annual Medicare Open Enrollment Period.
Additionally, if you would like to switch from your current Medicare Advantage plan to a Medicare Advantage plan that includes dental coverage, you also have the option to do so during the Medicare Open Enrollment Period.
Or, you can change your Medicare Advantage plan during the Medicare Advantage Open Enrollment Period that runs each year from January 1 to March 31.