Does Medicare Cover Dental?
Original Medicare does not provide coverage for routine dental care; however, there are options to fill this gap in coverage.
The short answer to new Medicare beneficiaries’ common question, “Does Medicare cover dental care?” is no. This is because dental plans are not integrated into Original Medicare (Medicare Part A and Medicare Part B).
Routine dental checkups are essential as a preventive measure for healthy teeth and gums. Still, you may also want a plan to cover dental because your dentist can detect markers for diseases like diabetes and heart disease. However, dental care is costly, so determine which Medicare plans offer coverage and, if not, what other options enrollees have.
Following are examples of non-covered routine dental care, services, and supplies:
Excluded dental procedures: Cleanings, tooth extractions, fillings, dental X-rays, root canals, and the replacement of a tooth or structure that directly supports a tooth
- Excluded dental devices: Dentures, implants, and crowns
The Medicare cover dental care omission has existed since the Medicare program was initially created. Medicare coverage also leaves out routine foot care, but benefits are available for most medically necessary podiatry services versus the blanket exclusion specific to dental work. However, there are a few Medicare cover dental care exceptions.
What Types of Medicare Cover Dental Care?
Benefits may be available under Medicare Part A (hospital insurance) if you need complicated dental work requiring hospitalization. Part A covered services include planned and emergency dental procedures if you are an inpatient and if the dental work is the reason you are hospitalized in the first place.
According to the Centers for Medicare & Medicaid Services (CMS), Medicare covers inpatients for oral exams if performed:
- As a component of a comprehensive workup before renal transplant surgery
- In a rural health clinic (RHC) or federally qualified health center (FQHC) before a heart valve replacement
Another Medicare cover dental care exception is for extractions if needed to get your jaw ready for radiation as a treatment for neoplastic disease (benign or malignant tissue that grows abnormally).
Medicare Advantage Dental Coverage
Although you don’t have a Medicare cover dental option with Original Medicare, you may find that opportunity with a Medicare Advantage plan (Part C). Medicare Advantage is an alternative health plan to Medicare that includes Part A, and Part B. Part C can offer benefits beyond the Original Medicare coverage. Extra benefits often include prescription drugs (Part D), vision care, and hearing and dental services.
If you have a Medicare Advantage plan, look in the plan’s provider directory for network dentists. Some plans provide an annual allowance and permit you to visit any licensed dentist. Note that you may need to pay upfront and submit for reimbursement. If the dental benefit draws you to Medicare Advantage, check to see if the allowance will meet your projected dental needs.
Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are the most common Medicare Advantage plans. HMOs generally require that you use the plan’s provider network. You may find more flexibility with PPO plans, but read your Evidence of Coverage (EOC) to confirm how dental coverage works for your specific plan. Medicare Advantage benefits extending beyond Original Medicare vary from one state and insurance company to another.
Medicare Supplement Dental Coverage
Medicare Supplement plans (Medigap) are designed to help with out-of-pocket costs like coinsurance and copays. Although some Medicare Supplement plans cover benefits excluded by Original Medicare, such as emergency healthcare during travel, dental plans are not part of the Medigap program.
How do you get Dental Coverage if Medicare doesn’t include it?
If your health insurance plan does not cover dental insurance, you may need to purchase a separate plan covering dental care. If you have a dentist you want to continue using, ask the office staff which insurance or discount plans your dentist accepts.
Other resources that you may find helpful:
- Marketplace online
- Private insurance companies
- Local dental clinics
- State insurance department
- Dental education institutions
While researching, remember that not all plans are dental insurance plans. You may find discount plans that enable you to get a lower rate for dental services, but you have to pay the dentist directly.
If you are eligible for Medicaid, check with your state Medicaid agency if dental benefits are available for adults. In addition, Medicaid must offer dental benefits to children, a benefit named Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
A licensed insurance agent can assist with identifying stand-alone dental plans in your service area that offer low-cost monthly premiums and reasonable deductibles.