Medicare and Dental Coverage
Original Medicare does not cover most dental care. It’s estimated that 65 percent of Medicare beneficiaries, roughly 37 million people, do not have any dental coverage. However, dental coverage is available through most Medicare Advantage plans.
Does Original Medicare Cover Dental?
Original Medicare (Part A and Part B) does not cover most dental care or services, and you will be responsible for 100 percent of costs for those services.
There are limited Medicare dental coverage exceptions. For instance, Medicare may pay for jaw, mouth or face reconstruction following an accident or for complex dental care necessary to protect your general health.
- In an acute care hospital.
- In a critical access hospital.
- In an inpatient rehab facility.
- In a long-term care hospital.
- Receiving inpatient care as part of a qualified research study.
- Receiving mental health care.
Dental Coverage Through Medicare Advantage
Many Medicare Advantage plans, but not all, include dental coverage. Medicare Advantage, or Part C, plans are sold by private insurers. They can help seniors pay for dental care.
Part C plans must include everything Original Medicare covers, but can offer additional coverage.
- Dental X-rays
- Fillings and related restorative services
- Gum disease and inflammation treatment
- Oral exams
- Root canal treatment
- Tooth extractions
If your Medicare Advantage plan only covers Medicare covered benefits, you may have to pay 100 percent out of pocket for dental services. It’s important to check what dental extras are included before purchasing a Medicare Advantage plan.
Other Dental Plans for Seniors
Almost half of Medicare beneficiaries have not been to a dentist in the past year and nearly 1 in 5 have spent $1,000 out of pocket for dental care in 2016, according to a 2019 survey by the Kaiser Family Foundation.
As you age, your dental health may require more effort and become more costly. While Medicare Advantage plans may offer you a means to offset the cost, there are other plans as well.
- Discount Dental Plans
- Also called “dental savings plans,” these allow you to pay a small monthly fee that gives you access to discounted dental services when you need them. Discounts can range from 10 percent to 60 percent of the actual cost.
- Some Medicare beneficiaries can be dual enrolled in Medicaid. This state-run medical program for low-income people will cover some dental benefits for eligible people and their families. States set their own guidelines, so what services are covered, if any, can vary from state to state.
- Dental and Dental Hygiene Schools
- Teaching facilities and clinics can provide high-quality, low-cost care to some people. Check with the American Dental Association to see if there is a program near you.
- Local Health Departments
- The U.S. Health Resources and Services Administration can direct you to local, community health centers in your area that provide low-cost dental services. Call 1-888-ASK-HRSA (1-888-275-4772).
- United Way
- United Way supports local, low-cost dental programs around the United States. You can search its General Dentistry database to see if there is a program near you.
7 Cited Research Articles
- Freed, M., Neuman, T., and Jacobson, G. (2019, March 13). Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries. Retrieved from https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/
- Humana. (2019, December 5). Ways for Seniors on Medicare to Get the Right Dental Coverage. Retrieved from https://www.humana.com/dental-insurance/ways-seniors-medicare-dental-coverage
- Delta Dental. (2019, August 6). Medicare Dental: What’s Covered? Retrieved from https://www.deltadentalwa.com/blog/entry/2018/07/medicare-dental-coverage
- Cigna. (2019, August). Does Medicare Cover Dental? Retrieved from https://www.cigna.com/individuals-families/understanding-insurance/does-medicare-cover-dental
- U.S. Department of Health and Human Services. (2017, September 18). Where Can I Find Low-Cost Dental Care? Retrieved from https://www.hhs.gov/answers/health-care/where-can-i-find-low-cost-dental-care/index.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Dental Services. Retrieved from https://www.medicare.gov/coverage/dental-services
- Delta Dental. (n.d.). Medicare Dental Insurance Coverage. Retrieved from https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/dental-insurance/medicare-dental-insurance-coverage.html