Does Medicare Cover Dental?
The short answer? No. Original Medicare does not provide coverage for routine dental care; however, there are options to fill this gap in coverage.
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:
- Tooth extractions
- Dental X-rays
- Root canals
- The replacement of a tooth or structure that directly supports a tooth
The Medicare covered 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 Medicare Plans Cover Dental Care?
Emergency 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 and 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.
- Extractions needed to get your jaw ready for radiation as a treatment for neoplastic disease.
How Do You Get Dental Coverage if Medicare Doesn’t Include It?
Since Medicare 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.
Dental care can often be covered using one of these options:
- A Medicare Advantage plan with dental coverage
- A dental discount plan (not full coverage, only a price discount)
- A stand-alone dental plan
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 will still have to pay the dentist directly.
Medicare Supplement Dental Coverage
Although some Medicare Supplement (Medigap) plans cover benefits excluded by Original Medicare, such as emergency healthcare during travel, dental coverage is not part of the Medigap program.
Medicare Advantage Plans With Dental Coverage
Although you don’t have a 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 and can offer benefits beyond the Original Medicare coverage. These additional benefits can often include some forms of dental care. 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. You may be able to find coverage in one of the most popular Medicare Advantage plans, such as the HMO and PPO plans.
Medicaid Dental Benefits
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, which is a benefit named Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
Ready to Learn More?
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.