Parts A (hospital care) and B (medical care) of Original plando not usually 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 do not cover dental supplies such as plates, dentures, orthodontic equipment or retainers.
However, some Medicare Advantage plans, also known as Medicare Part C plans, do include coverage for dental care. Each plan has different costs and details on how the benefits can be used.
Read on to learn more about your options for dental coverage through Medicare.
When does Original Medicare cover dental care?
While Original Medicare generally doesn’t cover dental care, there are a few exceptions worth mentioning. If you need dental care due to an illness or injury that requires hospitalization, your dental treatment may be covered.
For example, if you fall and break your jaw, Medicare may pay for surgery to rebuild your jaw bones.
Some complicated dental procedures are also covered if they’re done in a hospital, but whether they’re covered under Part A or Part B depends on who provides the service.
Medicare may also pay for your care if you need dental services due to oral cancer or another covered illness.
In addition, Medicare may pay to have a tooth removed if your doctors believe the tooth needs to be removed before heart surgery, radiation therapy, or some other covered procedure.
Medicare Advantage (Part C) and dental coverage
Medicare Advantage plans are offered by private insurance companies that have been approved by Medicare. These plans are an alternative to Original Medicare. They usually pay for services that are not covered by Parts A and B of Original Medicare.
With this type of plan, you may have to pay a monthly premium or coinsurance. You should also check to see if your dentist is in the plan’s network for 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 whether they cover dental services. Many Advantage plans include dental benefits.
To determine if your current Medicare Part C plan includes dental coverage, you can speak with an insurance representative or read the Evidence of Coverage (EOC) document you received when you enrolled in the plan.
Will Medigap coverage help pay for dental services?
Medigap coverage generally helps you pay copayments and deductibles related to services covered by Original Medicare. In most cases, Medigap doesn’t cover extra services like dental care.
How much does the average dental exam cost?
Depending on where you live, an annual dental cleaning and exam can cost between $75 and $200. That cost could be higher if you need a deep cleaning or x-rays.
What Medicare plans might be best for you if you know you need dental services?
Since most dental services and supplies aren’t covered by Medicare Part A and Part B, if you know you’ll likely need dental care in the next year, a Medicare Advantage Plan (Part C) may be a good option.
Be sure to consider your future needs as well as your family dental history when making your decision. Also consider whether you may need implants or dentures in the future.
Comparison of Medicare Plans for Dental Coverage
Medicare plan Does it cover dental services?
Medicare Parts A and B (Original Medicare) No (unless you sustain a serious injury involving your mouth, jaw, or face)
Medicare Advantage (Part C) Yes (however, not all plans are required to include dental services, so check plan details before enrolling)
Medigap (Medicare Supplement Insurance) Nope
Other dental coverage options
It’s also a good idea to consider dental coverage outside of Medicare. Here are some of the options:
- Independent dental insurance. These plans require you to pay a separate premium for coverage.
- Spouse or partner sponsored insurance plan. A less expensive option may be to sign up for coverage under a spouse’s dental plan, if possible.
- Dental services discount groups. These do not provide insurance coverage, but allow members to obtain dental services at a lower cost.
- Medicaid. Depending on the state you live in and your financial situation, you may be eligible to receive dental care through Medicaid.
- PACE. This is a program that can help you get coordinated care within your local community, including dental services.
Why it’s important to find good dental coverage as you age
Good dental care is vital to maintaining your overall health and well-being. Poor dental hygiene has been linked to chronic inflammation, diabetes, heart conditions, and other major health difficulties.
And according to some studies, it has been shown that people sometimes neglect their dental care as they age, usually due to the high price of dental care.
The National Institute of Dental and Craniofacial Research estimates that 23% of older people have not had a dental exam in the past 5 years. That figure is higher among black and Hispanic people and among people with lower incomes.
A 2017 nationwide survey found that cost was the most common reason people didn’t seek professional help to care for their teeth. However, 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 covers the dental services you need as you age.
TIPS TO HELP SOMEONE YOU LOVE ENROLL IN MEDICARE
- Step 1: Determine eligibility. If you have a loved one who will be 65 in the next three months, or who has a disability or End-Stage Renal Disease, they are likely eligible for Medicare coverage.
- Step 2: Talk about your needs. Here are some things to consider when deciding between Original Medicare or a Medicare Advantage plan:
- How important is it that you keep seeing your current doctors?
- What prescription medications are you currently taking?
- How much dental and vision care am I likely to need?
- How much can you spend on monthly premiums and other costs?
- Step 3: Understand the costs associated with late enrollment. If you decide not to enroll your loved one in Part B or Part D coverage, you may have to pay higher costs or penalties later.
- Step 4: Go to ssa.gov to enroll.Generally, you do not need documents and the process takes about 10 minutes.
Maintaining the health of your teeth and gums as you age is important for overall good physical health.
Original Medicare Parts A and B do not pay for dental services, including routine exams, dental extractions, root canals, and other basic dental services. They also do not cover dental supplies like dentures and braces.