Medicare and Dental Coverage Explained
This article was updated on: 09/12/2018
Does Medicare cover dental services?
If you’re wondering whether Medicare offers dental coverage, the answer is, “It depends.” Dental coverage is limited under Original Medicare, and you won’t be covered for most routine dental services. However, routine dental coverage may be available as part of a Medicare Advantage plan. Because Medicare Advantage plans are available through Medicare-contracted private insurance companies, benefits may vary by plan.
Here’s an overview of how Medicare dental coverage works and the situations where you may be able to get help with dental costs.
Original Medicare dental coverage
Original Medicare, Part A and B, does not cover routine dental care, including:
- Cleanings and oral exams
- Dental appliances, including dentures or dental plates
There are a few exceptions to this. Medicare Part A may cover certain dental services performed in a hospital if it’s a necessary part of a covered service. For example, if you need a preliminary oral examination before a surgery or organ transplant or if you need reconstructive jaw surgery, you may be covered for these dental procedures because the care is related to another service that Medicare does cover. You may also be covered for extractions if they’re needed to prepare your mouth for radiation for oral cancer. If you receive these services as an outpatient, you’d be covered under Part B.
If you need inpatient emergency hospital care because of a complication from a dental procedure, Part A will cover your inpatient hospital treatment, even if the dental services aren’t covered.
Keep in mind that even if Original Medicare covers a specific dental service, you may not be covered for post-treatment dental services once the specific issue has been treated. So, for example, in the case of Medicare covering reconstructive jaw surgery, it may not continue paying for dental care after that operation.
Medicare dental coverage under Medicare Advantage (Medicare Part C)
If you’d like to get more comprehensive dental coverage under Medicare, you might want to consider a Medicare Advantage plan, available under the Medicare Part C program. Offered through Medicare-contracted private insurance companies, these plans are required to offer at least the same coverage as Original Medicare (except for hospice); in other words, a Medicare Advantage plan would cover dental care under the same situations as Original Medicare. In addition, many Medicare Advantage plans offer additional benefits such as routine dental or vision care, wellness programs, and prescription drug coverage.
While Medicare dental benefits may vary by plan, some of the services you may be covered under a Medicare Advantage plan may include routine dental exams, cleanings, X-rays, fillings, crowns, root canals, and more. Some Medicare Advantage plans may require you to use dentists in provider networks when receiving care, or you may have the option to use non-network dentists but at a higher cost-sharing level; you can check with the specific plan you’re considering for more details.
Keep in mind that there may be certain costs related to your dental coverage, including deductibles, copayments, and or/coinsurance. In addition, you’ll need to keep paying your Part B premium if you enroll in a Medicare Advantage plan, along with any monthly premium required for your plan.
Medicare dental coverage under the PACE program
PACE (Program of All-Inclusive Care for the Elderly) is a joint Medicare and Medicaid program that provides health-care services for people living in a community so that they can delay institutional or nursing home-care for as long as possible. PACE covers all services covered under Medicare and Medicaid and if you enroll in the program, you’ll get all of your Medicare coverage through your PACE organization (including prescription drug coverage, doctor services, and hospital care) as long as your health-care team determines they’re necessary for your care. In addition, PACE may include certain benefits beyond the Medicare program, such as dental services.
You may be eligible if you’re 55 years or older and enrolled in Medicare, Medicaid, or both programs (also known as a “dual eligible”). You must also live in the service area of a PACE program; be able to live safely in a community environment (with support from PACE); and need a nursing home-level of care (as certified by your state). To learn more about PACE and see if you’re eligible, visit Medicare.gov.
Other dental coverage options
Outside of getting Medicare dental benefits through a Medicare Advantage plan or a PACE program, you may find yourself having to pay the full cost for most routine dental care if you’re enrolled in Original Medicare or in a Medicare Advantage plan that doesn’t include dental coverage.
Dental insurance may be another option if you want help with dental costs. Keep in mind that stand-alone dental plans are not part of the Medicare program, and this coverage may come with certain costs, including premiums, deductibles, coinsurance, and copayments.
In addition, if you have limited income and qualify for Medicaid benefits, some state Medicaid programs include dental coverage. Check with your state’s Medicaid program to see if you’re eligible for low-income assistance and if dental services are covered.
Learn more about Medicare dental coverage
If you’re interested in Medicare dental coverage, I can find Medicare Advantage plan options that may offer routine dental benefits. To learn more about me, see my photo below and click the “View profile” link read more about my background. You can schedule a one-on-one phone call or request an email from me with more plan information; find both of those links below as well. If you want to compare plan options now, click the Compare Plans button on this page.
This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.