Original Medicare parts A (hospital care) and B (medical care) don’t typically include dental coverage. That means Original (or “classic”) Medicare doesn’t pay for routine services like dental exams, cleanings, tooth extractions, root canals, implants, crowns, and bridges.
Medicare parts A and B also don’t cover dental supplies like plates, dentures, orthodontic equipment, or retainers.
While Original Medicare doesn’t generally cover dental care, there are some noteworthy exceptions. If you need dental care because of an illness or injury that requires a hospital stay, your dental treatment may be covered.
For example, if you fall and fracture your jaw, Medicare
Some complicated dental procedures are also covered if they’re performed in a hospital, but whether they’re covered by Part A or Part B will be determined by who provides the service.
Medicare may also pay for your care if you need dental services because of oral cancer or another covered illness.
In addition, Medicare may pay for a tooth extraction if your doctors think it’s necessary to remove the tooth prior to heart surgery, radiation therapy, or some other covered procedure.
Medicare Advantage plans, also known as Medicare Part C plans, are offered by private insurance companies that have been approved by Medicare. These plans are an alternative to Original Medicare. They often pay for services that aren’t covered by Original Medicare parts A and B.
For example, you may need to pay a monthly premium or a co-insurance payment, and you may need to see a dentist in the plan’s network if you want the service to be covered.
There are several ways to find out if a specific Medicare Advantage plan covers dental care. Medicare has a Find a Medicare Plan tool that shows you all the plans available in your area and what they cover, including if they cover dental. Many Advantage plans include dental benefits.
To determine if your current Medicare Part C plan includes dental coverage, you can talk to a representative from the insurer or read the details contained in the Evidence of Coverage (EOC) document you received when you enrolled in the plan.
Generally, Medigap coverage helps you pay for co-pays and deductibles related to services covered by Original Medicare. Most of the time, Medigap doesn’t provide coverage for extra services like dental care.
Depending on where you live, an annual dental cleaning and examination could cost between $75 to $200. That cost could be higher if you need a deep cleaning or X-rays.
Since most dental services and supplies aren’t covered by Medicare Part A and Part B, If you know you may need dental care in the next year, a Medicare Advantage (Part C) plan may be a good option.
When you’re making this decision, be sure to consider your future needs as well as your family dental history. If you think there’s a possibility you may need implants or dentures in the future, factor that into your decision-making as well.
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.
- Dental discount groups. These don’t provide insurance coverage, but they allow members to get dental services at a lower cost.
- Spouse or partner employee-sponsored insurance plan. If it’s possible to sign up for coverage under a spouse’s dental plan, that may be a less expensive option.
Good dental care is vital to maintaining your overall health and wellness. Poor dental hygiene has been linked to chronic inflammation, diabetes, heart conditions, and other serious health difficulties.
And studies have also shown that people sometimes neglect their dental care as they get older, often because dental care can be expensive.
The National Institute of Dental and Craniofacial Research estimates that 23 percent of seniors haven’t had a dental exam in the past 5 years. That figure is highest among African American and Hispanic people and among those who have lower incomes.
One nationally representative poll conducted in 2017 revealed that cost was the most common reason people didn’t seek professional help in caring for their teeth. Yet good preventive care can help you avoid more serious dental problems in the future.
For that reason, it’s a good idea to consider an affordable plan that’ll cover the dental services you need as you get older.
Tips for helping a loved one enroll in Medicare
- Step 1: Determine eligibility. If you have a loved one who is within 3 months of being 65, or who has a disability or end-stage renal disease, they’re probably eligible for Medicare coverage.
- Step 2: Talk about their needs. Here are some things to consider when deciding whether you want to elect Original Medicare or a Medicare Advantage plan:
- How important is it to keep their current physicians?
- What prescription medications are they taking?
- How much dental and vision care are they likely to need?
- How much can they afford to spend on monthly premiums and other costs?
- Step 3: Understand the costs associated with delaying enrollment. If you decide not to sign up your loved one for Part B or Part D coverage, you may have to pay penalties or higher costs later on.
- Step 4: Visit ssa.gov to sign up. You usually don’t need documentation, and the whole process takes around 10 minutes.
Keeping your teeth and gums healthy as you age is important to maintaining your overall physical health.
Original Medicare Part A and Part B don’t pay for dental services, including routine examinations, tooth extractions, root canals, and other basic dental services. They also don’t cover dental supplies like dentures and braces.
There are some exceptions, though: If you need complicated dental surgeries, or if you need dental services because of a covered illness or injury, Medicare may pay for your treatment.
Many Medicare Advantage (Part C) plans do offer dental coverage, but you may need to pay a monthly premium or use in-network dentists to take advantage of the coverage.