Summary: Dental and oral care is essential for your overall health and wellbeing. However, you may be surprised to learn the Medicare doesn’t provide dental coverage except for very specific situations. Below, we’ll take a look at what dental services Medicare does and doesn’t cover, and how Medicare enrollees can get comprehensive dental coverage. Estimated Read Time: 6 min
The Importance of Dental Care for Medicare-Eligible Individuals
Having access to quality dental care is important for individuals of all ages. However, Medicare-eligible individuals, including seniors and people with disabilities, face unique challenges when it comes to getting necessary dental care. According to the National Institute of Health, lack of dental insurance, underlying health conditions, and lack of convenient access to care are all factors that increase the risk of poor oral health.
Oral health can have a significant impact on your overall health and wellbeing. That’s why it’s important for Medicare beneficiaries to understand what’s covered by Medicare and what options you have for getting dental coverage.
Dental Services Covered by Medicare
Original Medicare (Medicare Part A and Medicare Part B) does not cover dental services in most cases. There is an exception: Medicare will provide coverage for inextricably linked dental services. Inextricably linked dental services are dental services that are integral to other medically necessary services or procedures.
This means Medicare will cover dental services that are directly related to another Medicare-covered service. For example, if you need treatment for an oral infection as part of a comprehensive workup prior to having an organ transplant, Medicare will pay for your oral care.
Medicare will also provide coverage for dental or oral complications after receiving radiation or chemotherapy treatment for head or neck cancer. In instances of jaw fractures or dislocation, dental services to stabilize or immobilize teeth may also be covered.
There are other specific instances where Original Medicare will pay for dental care that is necessary for a covered treatment or procedure. If you have an upcoming procedure that requires oral care, talk with your doctor about whether your care will be covered by Medicare.
Dental Services Not Covered by Medicare
Aside from the specific instances mentioned above, Medicare does not provide coverage for dental services. This includes routine and preventative oral care. Since Original Medicare’s dental coverage is so limited, many individuals with Medicare do not receive adequate dental and oral care. In fact, KFF.org reports that as of 2019, nearly half of Medicare beneficiaries did not have dental coverage of any kind.
Medicare Does Not Cover the Following Dental Services:
- Routine dental care such as teeth cleanings, tooth extractions, root canals, or dental fillings
- Dental care related to structures that support the teeth such as dental crowns, or dental bridges
- Implants, dentures and any dental services involved in preparing the mouth for either
- Extraction of an impacted tooth
- Dental plates or other dental devices
If you receive any of the above services and you do not have additional dental coverage, you will be responsible for paying 100% of costs.
You may be wondering, “Why doesn’t Medicare cover dental care?”. You aren’t alone – many individuals don’t know that Medicare doesn’t include dental coverage until after they lose their employer’s group insurance. Since its inception, the Medicare program has not included dental care as a covered service. However, in recent years there have been pushes to expand Medicare to include coverage for dental, hearing, and vision services. As of 2024, there has not been any legislation passed to make dental coverage a part of Original Medicare.
Though Medicare does not provide dental coverage, there are options for Medicare enrollees to receive coverage.
Does Medicare Advantage Cover Dental?
Medicare Advantage Plans are only required to cover services and supplies that are covered by Original Medicare; therefore, Medicare Advantage plans are not required to include dental coverage. However, in certain locations, some plans may offer coverage for services not covered by Original Medicare.
When comparing Medicare Advantage plans, you will want to review the Summary of Benefits and the Evidence of Coverage to see what is covered and what your out-of-pocket expenses will be. Many Medicare Advantage plans restrict their enrollees to a network of doctors. When enrolling in a Medicare Advantage plan, you want to be sure a dentist in your area will accept your plan’s coverage.
If your Medicare plan does not cover dental care, you may consider enrolling in a stand-alone dental insurance plan. It is important to understand that if you have a Medicare Advantage plan and choose to enroll in a dental insurance plan as well, you will be responsible for paying your Medicare Part B premium, your Medicare Advantage plan premium, and your dental insurance plan premium each month.
Dental Insurance Plans for Medicare Beneficiaries
Whether you have Original Medicare or a Medicare Advantage Plan, you have options when it comes to getting dental coverage. Ancillary insurance plans are stand-alone plans offered by carriers that provide coverage for services that are not covered by Medicare. Dental insurance plans are one of the most common types of ancillary insurance plans.
Dental insurance plans offered to Medicare beneficiaries are not regulated by or associated with the federal government; therefore, anyone can purchase a dental plan regardless of which Medicare coverage they have. Like other insurance plans, dental insurance plan availability and benefits will vary by carrier and location. Some insurance carriers offer plans specifically to meet the care and budget needs of seniors.
When you enroll in a dental plan, you will be responsible for paying your plan’s monthly premium in addition to any premiums you are currently paying for your Medicare coverage. Below are some other important things you should know as a Medicare beneficiary about dental insurance plans:
- Some dental plans may offer additional coverage, such as coverage for hearing or vision.
- In addition to paying a monthly premium, you may also be responsible for a deductible and/or copayments.
- Dental plans often have annual coverage limits; this means that if you hit the annual maximum, you will need to pay all additional costs.
- Many dental plans operate within a network, however not all do. Make sure to review plan details carefully when searching for and comparing plans.
- Some plans may require a waiting period for certain services or procedures. For example, a plan may require a six-month waiting period before you can get a tooth extraction.
- Most plans do not have waiting periods for preventative services such as annual cleanings.
Other Ways for Medicare Enrollees to Get Help with Dental Costs
For individuals who are unable to get dental coverage due to lack of plan availability or finances, there are other ways in which you can get help with dental costs.
- Dual-Eligible Individuals: If you are eligible for both Medicare and Medicaid, check with your state’s Medicaid office to see if they offer dental benefits to adults enrolled in Medicaid. There is currently no requirement for Medicaid to provide dental benefits to adult enrollees, so coverage will differ from state to state.
- The Dental Lifeline Network provides state programs for individuals with limited income who need help getting dental care.
- If a dental school is in your area, you may be able to get a procedure done at a discounted rate by a student looking to gain experience related to their field.
- Veterans may be able to get some or all of their dental coverage through the VA. You can visit their website to see if you qualify.
Oral Health in America Advances and Challenges Fact Sheet, National Institutes of Health. Accessed December 2023
Medicare Dental Coverage, Centers for Medicare & Medicaid Services. Accessed December 2023
Medicare and Dental Coverage: A Closer Look, KFF.org. Accessed December 2023
Dental Services, Medicare.gov. Accessed December 2023