Does Medicare Cover Dental Treatment? What it Covers, What It Doesn’t and Your Options
Learn what Medicare Parts A, B and C do and don't cover, and where Medicare Advantage fits in
Although private, employer-provided insurance plans often provide dental care as a benefit, many people are surprised to find that Medicare parts A and B do not cover routine dental procedures. To cover that, you’ll need to add a Medicare Advantage plan. “The number of people who think that dental care is an automatic benefit to Medicare is one of the largest surprises that I witness,” said Clayton Eidson, Founder and CEO of AZ Health Insurance Agents.
“Medicare offers you a good base but does not cover all aspects of your health. Dental care especially is a point which is easy to overlook.”
A Medicare Part C plan will cover routine dental procedures, such as exams, cleanings, fillings and dentures. “The trick is that the sooner you know your choices the better, be it the inclusion of a supplemental plan or other coverage options that ensure your future health,” Eidson said.
With such a confusing landscape, we’ll help you understand what your options are, what’s covered, what’s not and where Medicare Advantage plans can fill in the gaps.
In This Article
What Dental Care Does Medicare Cover?
When dental services are integral to the success of other Medicare-covered procedures or services, Medicare may pay under Parts A and B. Medicare may also cover some services you get if you’re admitted to a hospital for the procedure.
For example, an exam/treatment as part of an overall workup before an organ transplant or cardiac valve replacement would be covered, as it’s an essential part of the success of the procedure. Another would be oral treatment treating a mouth infection before chemotherapy.
Medicare will also pay for dental services performed as part of an inpatient hospital stay, but only when the patient requires hospitalization due to an underlying medical condition and clinical status or the severity of the dental procedure. If you need coverage for annual cleanings, preventive X-rays and any other routine dental treatment, you’ll need to add a Medicare Advantage plan to pay for it.
“In a hospital setting, Medicare Part A covers only some dental procedures that are medically necessary, like jaw surgery after an accident, or dental surgery that is required before a major surgery,” said Dr. Arun Narang of Smile By Design Dental.
Even with Medicare Part B, you’ll still pay something: 20% of the Medicare-approved amount after you meet the Part B deductible. If you get the covered service at an outpatient hospital or other setting, there will also be a copayment.
What Dental Care Does Medicare Not Cover?
If you’re used to going to the dentist twice a year for routine checkups and cleanings, and solving minor issues as they come up, Medicare parts A and B will not cover your regular trips to the dentist. Overall, Medicare doesn’t cover the treatment of teeth, or structures directly supporting teeth such as gums or supporting bone.
That includes most routine dental procedures, such as cleanings, fillings, root canals or extractions, or items like dentures and implants. You’ll pay 100% for the cost of such coverage, so be ready. In that case, a Medicare Advantage plan is a necessity.
“The majority of seniors select a Medicare Advantage (Part C) plan, which incorporates some dental care such as cleanings, X-rays, some of the more major work, or even just basic dental care,” Narang said. It pays to shop around, too. Different plans offer varying levels of coverage.
Why Get a Medicare Advantage Plan?
Medicare parts A and B, do not cover routine oral care treatment, and a Medicare Advantage (Part C) plan can cover a lot of your routine dental needs. Medicare Supplement (Medigap) plans can only help with out-of-pocket costs for original Medicare.
“For coverage options, people typically look at Medicare Advantage plans, which often include dental benefits, or standalone dental insurance plans,” said Yehuda Tropper, CEO of Beca Life Settlements. There are salso other options. “Some seniors also use dental savings plans or negotiate cash prices with dentists. Community health centers and dental schools offer reduced cost services too,” Tropper said.
Your typical Medicare Advantage plan will cover routine exams and cleanings while others will provide more comprehensive benefits. It depends on your individual needs.
“My advice to clients is simple,” said Eidson. “Medicare offers you a good base but does not cover all aspects of your health. Dental care especially is a point which is easy to overlook. The trick is that the sooner you know your choices the better, be it the inclusion of a supplemental plan or other coverage options that ensure your future health coverage.
FAQs
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What dental services are covered by Medicare?
Only those services that are required to treat another, Medicare-covered, condition, and in certain cases as part of an inpatient hospital stay.
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Is routine dental care covered under Medicare?
Routine dental care is not covered under Medicare. Dental services are only covered if they are essential to the treatment of another underlying condition covered by Medicare.
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What is the best dental insurance for someone on Medicare?
A Medicare Advantage (Part C) plan will cover dental services, where Medicare parts A & B do not except in certain circumstances, such as part of a hospital stay or where oral treatment is essential to another, underlying condition.
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Why don't dentists accept Medicare?
According to the American Medical Association, medicine and dentistry had been treated as separate fields since the 1800s, and only recently has the connection between dental care and overall health been established. Also Medicare, when it was established in 1965, was primarily designed to cover hospital and medical services.
