Traditional Medicare Typically Doesnt Cover Any Dental Services But Some Types Of Medicare Provide Limited Coverage
More than 60 million Americans receive health insurance coverage through Medicare¹. But does Medicare cover dental care? While Medicare pays for a wide variety of health care expenses, typically it does not cover most dental procedures, dental care, or supplies. This means that if youre currently on Medicare, it might be a good idea to purchase dental insurance to help you maintain good oral health while saving on out-of-pocket costs.
Medicare Dental Coverage Under Medicare Advantage
If youd 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 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 youre 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, youll 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.
Can A Medicare Supplement Plan Help
Medicare Supplement Plans help fill in the gaps in standard Medicare coverage . There are a variety of Medigap plans out there, each with their own advantages for different folks. However, most supplement plans only cover emergency dental procedures.
If you get your health coverage through a Medicare Advantage plan, you may have coverage for certain dental services.. In some cases, you may need to look for private dental insurance to cover out-of-pocket services.
Some Medicare Advantage plans include dental coverage. Contact us at to learn about Medicare plans that may include some dental coverage.
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How Much Does Medicare Advantage Dental Coverage Cost
You generally will pay a copayment or coinsurance for most Medicare Advantage dental coverage, such as 50% coinsurance or a $50 copayment. If you have a Medicare Advantage plan that only covers Medicare covered benefits you may have to pay for routine services, such as cleanings and fillings 100% out of pocket. Medicare Advantage plans with more comprehensive dental coverage may have higher monthly premiums.
You also may have to use a provider within the plans network in order to be covered. There also may be an annual limit on Medicare Advantage dental coverage, for example, $1,000.
Does Medicare Cover Dental Health
En español | Original Medicare has no dental plan. It does not cover most routine dental services such as exams, cleanings and X-rays procedures related to dental health, such as fillings, extractions and root canals or dentures and other dental devices.
However, original Medicare can pay some costs associated with emergency or medically necessary dental care.
For example, Medicare Part A, which includes hospital insurance, could cover having teeth pulled in preparation for radiation treatment of jaw cancer, or inpatient care if you need a complicated or emergency dental procedure while in the hospital, such as jaw reconstruction after an accident.
If you rely on Medicare and want coverage for regular oral care, look into Medicare Advantage plans. These policies, offered by private insurance companies, include all original Medicare coverage and often have extra benefits such as dental services .
Another option is Medicare Supplemental Insurance, better known as Medigap. These plans, also sold by private insurers, cover some out-of-pocket costs for Medicare treatment. They do not specifically include extra benefits, but some Medigap providers offer clients options for dental coverage, or discounts on out-of-pocket costs for oral care. If you have Medigap, ask if your provider offers related dental benefits.
Editor’s note: This article was originally published on July 15, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.
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Will Medicare Pay For My Dentures
A few basics about dentures, dental care and how to pay for it
This article is reprinted by permission from NerdWallet.
Original Medicare doesn’t pay for dentures or related dental appointments for fittings or tooth extractions. To get some coverage of these substantial costs, you’ll need to enroll in Medicare Advantage or private dental insurance.
Medicare excludes all dental services, except in some specific and unusual circumstances where dentistry or oral surgery is required in a broader plan of medical treatment. But dentures are never covered.
There are different types of dentures
Before you consider whether to get dental coverage through Medicare Advantage or a private insurer, it helps to understand a few basics about dentures.
Partial versus full dentures: Partial dentures are recommended when you have enough healthy teeth in the correct positions to anchor a dental appliance. Full dentures replace all upper and/or lower teeth.
Removable versus implant dentures: You take out removable dentures each night to clean them. Implant dentures are installed permanently with surgery that embeds them in your jaw. Removable dentures are typically much less expensive than implant dentures.
Ask a dentist or prosthodontist to evaluate your potential need for dentures and to estimate the cost, which will help you decide on a Medicare Advantage plan or private dental insurance.
What Medicare Advantage may cover
What private or group dental insurance may cover
So Where Should You Go For Dental Coverage
Medicare Advantage plans, which are private health insurance plans, cover everything that Medicare Parts A and B cover, and some of them also offer dental benefits. Many cover routine preventive care, such as cleanings, X-rays, and regular exams, either partially or in full. You may also find coverage for things like extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.
Like other private health insurance plans, Medicare Advantage plans come in a variety of types, including HMO and PPO plans, as well as private fee-for-service plans. And Medicare Advantage plans generally have a monthly premium in addition to the premium for Medicare Part B, which is $144.60 in 2020.
But there are some disadvantages to Medicare Advantage plans, such as a more limited list of approved doctors and hospitals. So make sure you understand what youre getting. You will also need to use a dentist in the Medicare Advantage network, so if you have a dentist you like, check to see if they are in the network. Compare costs and benefits for plans in your area before buying. You can search for a plan using Medicares Plan Finder.
Otherwise, if you stick with Medicare as your primary insurance, youll need to get separate dental insurance or pay for dental care out of pocket. You can check the costs of private dental plans using a broker site online.
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Medicare Part B Dental Benefits
On the other hand, if the physician conducts the examination needed prior to kidney transplant or heart valve replacement, the CMS states that Part B benefits will apply.
However, when it comes to Medicare Part B, there are two specific sets of services that it will not cover.
The first involves services used to care, treat, remove, or replace teeth to structures supporting the teeth. For example, this can include pulling teeth prior to getting dentures.
The second set of services Medicare Part B wont cover also include those related to the teeth and their supporting structures, unless those services are needed to effectively treat a non-dental condition.
In this type of situation, the dental service must be performed at the same time as the covered service in order for Medicare to pay its portion. It must also be performed by the same healthcare professional who performed the covered service, whether that person is a physician or dentist.
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Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
Does Medicaid Cover Dental For Adults
Medicaid covers dental care for adults only in certain states, and each of these states chooses whether they want to provide limited, extensive, or emergency-only care. The states that currently provide at least limited dental care for their Medicaid base population are: AK, CA, CT, IA, MA, MO, NJ, NM, NY, NC, ND, OH, OR, RI, WA, WI.
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Medicaid Dental Coverage By State
Extensive Medicaid dental coverage
No Medicaid dental coverage
Expanded Medicaid under the Affordable Care Act
Alaska, California, Connecticut, Iowa, Massachusetts, Montana, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, Washington, Wisconsin
Arkansas, Colorado, Ilinois, Indiana, Kansas, Kentucky, Lousiana, Michigan, Minnesota, Montana, Nebraska, Pennsylvannia, South Carolina, South Dakota, Vermont, Virginia, Wyoming
Arizona, Florida, Georgia, Hawaii, Idaho, Maine, Maryland, Mississippi, Nevada, New Hampshire, Oklahoma, Texas, Utah, West Virginia
Alabama, Delaware, Tenessee
Arizona, Hawaii, Maryland, Nevada, Hew Hampshire, West Virginia, Arkansas, Colorado, Illinois, Indiana, Kentucky, Louisiana, Michigan, Minnesota, Pennsylvania, Vermont, Alaska, California, Connecticut, Iowa, Massachussets, Montana, New Jersey, New Mexico, New York, Ohio, Orgegon, Rhode Island, Washington
As you can see from this table that shows Medicaid dental coverage by state, different benefits are given to those in the Medicaid base population and Medicaid expansion population.
People who fall into the Medicaid base population are those who were receiving Medicaid before the Medicaid Expansion Program under the Affordable Care Act.
People who fall into the Medicaid expansion population are those who began receiving Medicaid benefits after the ACA gave states the option to expand funding for Medicaid.
Does Medicare Cover Medications Before Or After Implant Surgery
Medications you may need before or after implant surgery, such as antibiotics and pain meds, are covered by the drug benefit associated with your MA plan or by Medicare drug coverage Part D, if you have that instead of a MA plan. Part D or your MA plan with drug coverage will only pay for medications that are on the plans formulary. Typically, you will have copay or coinsurance costs, which will vary depending on which tier of drug your dentist prescribes for you.
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Comparing Medicare Plans For Dental Coverage
You may also want to consider dental coverage outside of Medicare. You may have options, such as:
- Stand-alone dental insurance. These plans require you to pay a separate premium for coverage.
- Spouse or partner employee-sponsored insurance plan. If its possible to sign up for coverage under a spouses dental plan, that may be a less expensive option.
- Dental discount groups. These dont provide insurance coverage, but they allow members to get dental services at a lower cost.
- Medicaid. Depending on the state you live in and your financial situation, you may be eligible for dental care through Medicaid.
- Program of All-Inclusive Care for the Elderly . The PACE program can help you get coordinated care within your local community, including dental services.
What Happens During A Root Canal
The American Association of Endodontists describes the process like this:
- The dentist numbs the affected tooth and places a dental dam around it to keep it clean and dry during the procedure.
- She then drills a small hole in the tooth, inserts special instruments into the hole to clean the infection from the canals, and shapes the tooth for filling and restoration.
- The canals are filled with a rubbery material called gutta-percha and then sealed.
- The dentist then places a temporary filling to close the hole.
- A crown or other restoration is placed to restore the tooth and return it to full function.
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Who Can Get Dental Coverage Under Medicare
Children aged between 2 and 17 whose parents receive certain Centrelink benefits such as the Family Tax Benefit Part A are eligible for the Child Dental Benefits Schedule . The benefits are capped at $1,013 per child every 2 years and can pay for examinations, X-rays, cleaning, fissure sealing, fillings, root canals and extractions. It doesn’t cover orthodontic, cosmetic or in-hospital dental treatment though.
Concession card holders
Health Care Card, Centrelink Pensioner Concession Card or Department of Human Services Card holders are often eligible for free dental through Medicare. State public dental services can cover you for general dental, emergency dental services and, in some cases, referrals to specialist hospital services like orthodontics.
Medicare Advantage Plans May Cover Oral Surgery And May Cover Other Dental Care
By law, Medicare Advantage plans must provide the same minimum benefits as Medicare Part A and Part B, with the exception of hospice care, which you still receive from Medicare Part A. This means that qualified oral surgery is covered by a Medicare Advantage plan in the same way that it is by Medicare Part A and Part B.
Some Medicare Advantage plans may also provide coverage for routine dental services such as dental exams, fillings, tooth extractions, dentures and more.
Find Medicare Advantage plans that help cover oral surgery
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About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
Assessment Approach: Intervention Population And Outcomes
The selection of conditions and services for assessment was guided in part by historical context. A few months before the passage of the 1997 Balanced Budget Act, legislation had been introduced, first, to cover a specific set of medically necessary dental services that were described as cost-effective and, more generally, to provide for future coverage of other services subsequently determined to result in reductions in expendituresthat exceed expenditures resulting from such coverage . This latter requirement is quite stringent generally, services are considered to be cost-effective whether or not they produce cost savings that fully offset direct service costs. The more restrictive language reflects the rules that Congress has adopted requiring increases in spending in one area to be offset by cuts elsewhere or by increased taxes.
The five conditions listed in the 1997 bill had been presented in prior analyses of health conditions that sought to identify those for which the cost of covering inpatient dental services would likely be offset by savings related to complications avoided, especially additional hospitalization . The five conditions were
valvular heart disease.
The population of interest includes Medicare beneficiaries age 65 and over as well as younger people qualified for Medicare on grounds of disability or diagnosis of end-stage renal disease . Evidence related to all age groups was reviewed.
Does Medicare Part B Cover Dental
Medicare Part B does not cover any dental services. Dental insurance for seniors on Medicare is recommended in order to make sure that seniors get the routine care that they need like cleanings, exams, and fillings. Dental insurance can also help cover the cost of dentures, which Medicare typically doesnt cover.
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Find Cheap Medicare Plans In Your Area
Original Medicare does not provide comprehensive dental care, and Medicare Part A will only cover select dental services that require hospitalization. For most types of dental care, such as cleanings, X-rays or root canals, you’ll need dental coverage through a Medicare Advantage plan, a standalone dental plan or Medicaid.
What Dental Procedures Are Covered By Medicare
The bad news is that Medicare doesnt cover routine dental care such as cleanings, extractions, root canals, dentures, or implants.
For example, Medicare Part B will likely cover the cost of a dental exam before getting a heart valve replacement or kidney transplant. And Medicare Part A will cover the cost of tooth extractions that are needed for reconstructive jaw surgery resulting from an injury.
So, the bottom line when it comes to Medicare and dental procedures, is that Medicare will only cover dental expenses if the needed procedure is in combination with another medically necessary procedure.
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How To Find The Best Dental Insurance For Seniors On Medicare
Nearly two-thirds of Medicare enrollees have no dental insurance¹². Chances are, if youre unemployed, or retired and on Medicare, youre likely no longer receiving dental insurance benefits from a full-time employer. But that doesnt mean you cant get dental insurance coverage. Purchasing direct dental insurance is an option for seniors who may have lost dental benefits once they retired. Plus, its available for purchase all year round online, so you dont have to wait for a designated enrollment period. You could get approved for a plan within minutes.People over 65 are at an increased for oral health problems, such as gum disease 12, and without dental insurance, you might find yourself putting off treatment. Advancing age can bring all kinds of dental and periodontal issues, many of which need proper treatment to prevent further health issues that result from them. Having a comprehensive dental insurance plan is an important part of helping maintain oral health. There are a few dental issues that typically impact seniors more than other people, these include: