Does Medicare Include Dental Insurance?
Yes, Medicare does cover certain types of dental procedures, but only in select situations. Original Medicare (Part A and Part B) may cover dental care, but only when it is deemed medically necessary, such as if the dental work is part of another Medicare-covered surgery.
Original Medicare does not cover routine dental care, including oral checkups, cleanings, and fillings; however, most Medicare Advantage plans provide dental benefits, as well as vision and hearing services. Medicare beneficiaries may also purchase a stand-alone dental health care plan to ensure they receive the preventive dental benefits they need.
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The Importance of Oral Health
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. In fact, 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.
How Does Dental Treatment Work With Medicare?
Original Medicare only covers emergency dental care when medically necessary and as related to a separate covered condition or procedure. For example, if your jaw is fractured and requires surgery, any dental work included as part of that surgery would be covered. However, routine services such as root canals and cavity fillings would not be covered.
Eligibility
In most cases, your dental care must be deemed medically necessary for Original Medicare to provide coverage. The term “medically necessary” includes dental care needed to save your life or maintain your overall health.
Medicare may also offer limited dental benefits to treat injuries from an accident or directly support another Medicare-covered procedure. You may also be eligible for dental care through Original Medicare if you need a dental procedure to ensure the success of a subsequent surgery or service.
Available Treatments and Services
The following are examples of the limited dental treatment and services covered through Original Medicare:
- Surgery to treat jaw or facial fractures
- Dental wiring or splints required after emergency jaw surgery
- Oral exam before a heart valve replacement surgery (may be required to take place in a Federally Qualified Health Center)
- Jaw reconstruction surgery after the removal of a facial tumor
- Oral exam (after admission to the hospital) before a kidney transplant
- Dental services related to radiation therapy for jaw cancer and some other oral diseases
Which Medicare Part Covers Dental Services?
Original Medicare may cover dental services through Part A or Part B, depending on where and how the treatment occurs. Medically necessary oral exams or dental procedures that occur in a hospital and are performed by a dentist on hospital staff are considered Part A benefits. When performed by a physician, these services are covered through Part B.
How Medicare Advantage Covers Dental Care
Medicare Advantage plans, also called Medicare Part C, provide at minimum the same benefits as Medicare Part A and B. These plans also often offer additional benefits, such as dental coverage, prescription coverage (Medicare Part D), vision coverage, and hearing coverage.
Medicare Advantage plans are offered by private insurers, and so often have their own insurer-specific rules for coverage. For example, you may need a referral from your primary care physician 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 your preferred dentist is within your Medicare Advantage plan’s network to avoid out-of-network charges. 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.
Dental Options Outside of Medicare
You may also seek dental coverage separate from your Medicare benefits. Check to see if you are eligible for special employer or state-sponsored programs.
Stand-alone Plans
You can get a stand-alone dental plan that offers coverage only for dental services and is not linked to your Medicare enrollment. These plans tend to have more comprehensive dental coverage, such as offering 100% coverage for preventive care like checkups, 80% for basic services like pulling teeth, and 50% for more extensive jobs such as crowns, root canals, and bridges. The costs and the services covered vary depending on your chosen plan.
A private plan would not be linked to your Medicare plan, but it would help provide dental coverage where Medicare does not.
Employer Healthcare
Some Medicare beneficiaries are still working. In this case, they may prefer to keep their employer-sponsored coverage, which may include dental benefits. Employees may also be able to keep their healthcare benefits — potentially including dental coverage — through their employer even after they retire. However, this option is uncommon.
Medicaid
Medicaid provides health care for low-income individuals, families, and children; pregnant people; and people living with disabilities. Eligibility differs by state. Medicaid beneficiaries pay for none of the covered costs, or they contribute a small copayment. In every state, Medicare covers routine and emergency dental care for those under 21 years old. However, states are not required to cover adult dental care in the Medicaid program. For example, Medicaid does not cover adult dental care in Alabama, Delaware, or Tennessee.
But 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 Hygiene Schools
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. 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.
Can Medicare Recipients Get Dental Coverage Through the ACA Marketplace?
No, you may not have both Medicare and a policy purchased through the ACA Marketplace. This rule applies even if you receive only Part A or B benefits. If you have an ACA plan and do not qualify for employer-sponsored benefits, you must enroll in Medicare when you turn 65.
Instead, you can access dental benefits through stand-alone plans outside of the ACA Marketplace or with a Medicare Advantage plan.
How To Choose the Best Dental Coverage For Your Needs
Most major insurance carriers offer standalone dental plans geared toward seniors who will use the benefits in coordination with Medicare. Follow these steps to enroll in a dental policy:
- Know your priorities: Consider your primary criteria and goals for dental coverage. Many seniors seek a dental plan that covers the routine services Medicare doesn’t — like checkups, teeth cleanings, and fillings — with deep discounts and affordable premiums.
- Compare plans: You may work with a broker, agent, or contact carriers directly to ask about dental plans. Compare your area’s available options by covered services, provider networks, and average costs.
- Complete enrollment process: Many plans allow you to apply online and receive confirmation of coverage and a temporary ID card on the same day. However, be sure that you understand the policy’s terms before enrolling.
How Much Does Dental Coverage Cost?
Like broader medical coverage, dental insurance costs may include copays, coinsurance, deductibles, and out-of-pocket expenses. Monthly premium costs can vary widely by plan and may significantly affect the overall cost. The following are approximate costs:
Type of Dental Plan | Approximate Average Monthly Premium |
|---|---|
Stand-alone Plans | $50 per month in premiums |
Medicare Advantage | $20 per month in premiums |
Medicaid | Varies by state |
Employer Healthcare | $20-$50 per month in premiums |
Is Medicare Going to Offer Dental Insurance Soon?
Based on America’s history of keeping medical and dental insurance separate, Medicare will not likely incorporate dental benefits into its basic coverage. Congress could not pass the Medicare Dental Benefit Act of 2021 due to successful opposition from dental professionals in the American Dental Association and America’s Health Insurers.
Dentists generally oppose rolling dental benefits into Medicare for fear of pay cuts and due to this issue being politicized in recent years. Insurers have limited cost-sharing opportunities and thus tend to prioritize emergency treatment over preventive care. President Biden proposed adding dental coverage to Medicare in his 2022 budget; however, it has not been added as yet.
Putting It All Together
Medicare may not offer routine dental coverage with Part A and B benefits, but you can still get dental benefits through Medicare Advantage or a stand-alone dental insurance plan. Without separate dental coverage, Original Medicare only covers emergency or medically necessary dental procedures related to other Medicare-approved surgeries or treatments.
However, as a Medicare beneficiary, you can access several types of dental coverage policies. You may prefer a Medicare Advantage plan’s bundled dental, vision, and hearing benefits. Other cost-effective options include stand-alone dental plans. Alternatively, you may be eligible to keep your employee benefits if you are still working.