Original Medicare doesn’t typically include routine dental coverage. However, many Medicare Advantage (Part C) plans do include dental.
Since Original Medicare — Part A (hospital care) and Part B (medical care) — doesn’t include dental benefits, it means the cost of routine services like dental exams, cleanings, and tooth extractions will fall on you. Medicare also doesn’t cover dental supplies like dentures, orthodontic equipment, or retainers.
However, many Medicare Advantage (Part C) plans do include coverage for dental care. Each plan has different costs and details on how these benefits can be used.
Read on to find out more about your dental coverage options through Medicare.
While Original Medicare generally doesn’t cover dental care, there are some exceptions. If you need dental care because of an illness or injury that requires a hospital stay, your dental treatment may be covered.
Some examples of when dental care may be covered include the following:
- If you fall and fracture your jaw, Medicare may pay for the surgery to rebuild the bones in your jaw and fix any damaged teeth.
- 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 whether you’re an inpatient or an outpatient.
- You may receive coverage if you need dental services because of oral cancer or another covered illness.
- 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 Part A
If you know that you will require a medically necessary dental procedure to treat a medical condition, you may get coverage under Medicare Part A if you are a hospital inpatient.
Medicare Part B
If you need to have a medically necessary dental procedure performed on an outpatient basis, Medicare Part B may cover it.
Medicare Part C
Medicare Advantage plans are offered by private insurance companies that Medicare has approved. These plans are an alternative to Original Medicare and often pay for services that aren’t covered by parts A and B.
With this type of plan, you may need to pay a monthly premium or a coinsurance payment. Medicare Advantage plans typically have provider networks, so you should check to see whether your dentist is in the plan’s network.
To determine if your current Medicare Part C plan covers dental, you can talk with a representative from the insurance company or read the details contained in the Evidence of Coverage (EOC) document you received when you enrolled in the plan.
Medigap
Generally, Medigap plans help cover the out-of-pocket costs of Original Medicare, such as copays and deductibles. Most of the time, Medigap doesn’t provide coverage for extra services like dental care.
Comparing Medicare plans for dental coverage
| Medicare plan | Dental services covered? |
|---|---|
| Original Medicare (parts A and B) | no, unless you have a serious injury that affects your mouth, jaw, or face |
| Medicare Advantage (Part C) | sometimes, though not all plans are required to include dental, so check plan details before enrolling |
| Medigap (Medicare supplement insurance) | no |
You may also want to consider dental coverage outside of Medicare. Potential options include the following:
- Stand-alone dental insurance: These plans require you to pay a separate premium for coverage.
- Spouse or partner employee-sponsored insurance plan: If you can sign up for coverage under a spouse’s dental plan, that may be a less expensive option.
- Dental discount groups: These don’t 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 (PACE): The PACE program can help you get coordinated care within your local community, including dental services.
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.
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For that reason, it’s a good idea to consider an affordable plan that will cover the dental services you need as you age.
Keeping your teeth and gums healthy as you age is important to maintaining your overall physical health.
Original Medicare parts A and B don’t pay for routine dental services, including 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. Medicare may pay for your treatment if you need complicated dental surgeries or dental services because of a covered illness or injury.
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.