How to Get Better Dental Coverage from Medicare

Keeping your teeth healthy is important. In fact, there is increasing evidence that oral health and overall health conditions like diabetes and heart disease are linked, suggesting that regular dental checkups could reduce the chances of developing these issues.

Unfortunately, dental care can be costly. COVID-19 has impacted dental costs too; in a 2021 poll, the American Dental Association reported that one of the most common actions taken by dentists to remain financially viable was to raise their fees. Out of pocket, these fees can quickly add up. Dental insurance, however, could help offset the costs of routine exams and cleanings, as well as emergency procedures like dental surgeries.

People currently enrolled in Medicare Part A and Part B can find additional dental coverage through Medicare Advantage (Part C) plans that offer dental benefits or a standalone dental insurance plan, as dental benefits on Original Medicare are limited. Learn more about your options for dental coverage while on Medicare.

Does Original Medicare Include Dental Coverage By Default?

Medicare Part A and Part B cover dental services in very specific circumstances. They have to be part of another covered procedure, like jaw reconstruction after a car accident or treatment for a neoplastic disease that involves the jaw. In some cases, the hospital care connected to the dental procedure is covered, but not any of the work performed by a dentist.

Medicare sometimes will pay for dental exams before organ transplants, heart valve replacements, and other major surgeries. However, Medicare Part A and Part B do not cover the majority of dentures or routine dental care like cleaning or cavity repair. 

There have been recent proposals to add dental service to Medicare, including the Medicare Dental Benefit Act of 2021, which at the time of this publication is not moving forward. The act would have added dental coverage to Medicare Part A and Part B, covering oral health services for those with Medicare. This would have included routine diagnostic and preventive services, emergency care, and dental prostheses.

As such, dental coverage is still not part of Original Medicare, but it is possible that Congress could pass an updated version of the Medicare Dental Benefit Act in the future.

Your Options for Adding More Dental Coverage to Your Medicare Plan

You can supplement Medicare Part A and Part B with Medigap also known as Medicare supplement insurance. Though these plans do not offer any additional dental coverage, they could help lower copays and deductibles for those procedures, depending on the policy. Other options include enrolling in a Medicare Advantage or Part C, which may offer dental service, or finding an independent, stand-alone dental insurance plan.

Medicare Advantage Plans

Medicare Advantage plans, also called MA plans or Medicare Part C, provide at a minimum the same benefits as Medicare Part A and B, but they can offer additional dental coverage for extra fees. They can also have lower copays, prescription coverage (Medicare Part D), vision coverage, and hearing coverage. Some plans also cover transportation to doctor visits, services that promote wellness, and over-the-counter drugs.

Medicare Advantage plans are approved by Medicare, and they are offered by private insurers. As such, they must follow the rules set by Medicare. For example, you may need a referral to see a specialist to have it be covered by your plan. This could apply to the dental benefits offered by some Plan C options. 

Some insurers may not cover services from non-emergency providers outside the plan’s network or service area, so ensure that if you are interested in a Medicare Advantage plan that your preferred dentist is within network to avoid out-of-network charges. The average monthly Medicare Part B premiums in 2022 are $170.10, and people with Medicare Advantage also pay about $19/month extra for additional coverage. 

Because these plans are offered by private insurers, each has its own copays, deductibles, and benefits. Compare these when shopping for a Medicare Advantage plan to determine which one best suits your needs. 

After you sign up for a Medicare Advantage plan, keep your Medicare card in a safe place in case you decide to switch back to Original Medicare. Your new Medicare Advantage plan will send you a new insurance card.

Separate, Stand-alone Dental Plan

You can get a separate dental plan that’s unrelated to Medicare Advantage or any other form of Medicare health plans. A high-coverage plan that costs more in monthly premiums but is lower in deductible and copays would be a good fit for those who would likely utilize dental services frequently.

The costs and the services covered vary depending on the plan you choose. Many private dental plans pay for 100% of preventive care like checkups and cleaning, 80% of basic services like pulling teeth or filling cavities, and 50% of more extensive jobs such as crowns, root canals, and bridges.

A private plan would not be linked to your Medicare plan, but it would help provide dental coverage where Medicare does not. Private coverage usually costs from $20 to $80 a month for plans with $50 to $100 deductibles and an annual coverage limit of about $1,500.

Things to Consider When Looking for Dental Coverage

When looking for dental coverage, think about the copays for different services, the types of services covered, the rates, and the deductibles.You can call your dentist to make sure they take your new insurance. If you need expensive dental work, getting a second opinion and comparing your out-of-pocket costs with different dentists may also help you determine what type of additional dental option would best work for you.

Other Dental Care Options Outside of Medicare and Insurance

You can receive dental treatment outside of Medicare or private insurance by using Medicaid, state resources, or a dental school. There are other options available for people over 65 as well.  

Employer-sponsored Health Coverage

Those who are retired may maintain their health insurance and dental coverage through a former employer if the employer offers retiree coverage. However, employer-sponsored coverage could change, premiums could change, or the policy could be canceled altogether.

Medicaid

Medicaid provides health care for low-income families and children, pregnant people, and people living with disabilities. In some states, low-income adults are also eligible to receive Medicaid. State and local governments run Medicaid while following Federal guidelines, and some people can use Medicaid and Medicare to pay different parts of their medical expenses at the same time.

Patients pay for none of the covered costs, or they contribute a small copayment. Medicaid sends payments directly to health care providers. In every state, people under 21 get routine and emergency dental care. However, states are not required to cover adult dental care in the Medicaid program. Medicaid does not cover adult dental care at all in Alabama, Delaware, or Tennessee.

Other states may provide varying levels of dental coverage. For example, Utah and several other states cover emergencies only, while others will cover preventative care as well, such as routine cleanings and fluoride treatments. Contact your state’s Medicaid office to determine what dental benefits you may receive.

Dental and Dental Hygiene School Clinics

Schools for dentists and dental hygienists often host clinics that are open to the public. At these clinics, dental students perform work on patients under the supervision of experienced instructors. These clinics typically charge less for services than a dentist’s office, and many also accept Medicare Advantage and other dental insurance.

Some require appointments, and others can see emergency patients on a first-come, first-serve basis. Some dental schools also let patients participate in clinical trials to test new dental products or procedures. You can contact universities and community colleges to find dental clinics near you.

State Resources

The Health Resources & Services Administration (HRSA) is a Federal program that funds many state or local health centers. They offer medical care, dental care, and mental health treatment on a sliding scale based on patients’ ability to pay. Your state or local health department would have information about programs in your area that offer free or reduced-cost dental care. 

Additional Resources

• Medicare.gov – Dental Services
• Medicare.gov – What’s Medicare Supplement Insurance (Medigap)?