Does Medicare Cover Dental? Learn More About Your Benefits (2024)

Medicare covers a wide range of services, but some of those services are limited. Dental care is one of them, even though taking good care of your teeth and gums is important not just for your mouth, but for your overall health.

Medicare is a federal program for adults 65 and older and for people who have certain disabilities regardless of their age. More than 63 million people are on Medicare.

When you consider that 13% to 17% of people 65 and older are missing all of their teeth, you realize that many people may not be getting the dental care they need.

This article will discuss what dental services Medicare covers and how you can get dental care when you need it.

Does Medicare Cover Dental Care?

When it comes to Medicare, you have two main options. You can either enroll in Original Medicare or a Medicare Advantage plan. You cannot have both. Understanding the difference is important when it comes to dental care.

Original Medicare is Medicare Part A and Part B. It is referred to as “original” because these parts of Medicare came into existence when the Social Security Amendments were first passed in 1965.

In 1997, Medicare Part C was created. It was initially called Medicare+Choice, but its name was changed to Medicare Advantage in 2003.

These plans cover everything Original Medicare does, but they are overseen by insurance companies rather than the federal government. The insurance companies are allowed to offer additional services, known as supplemental benefits, above and beyond what Original Medicare covers.

Original Medicare covers dental care, but in limited circ*mstances. Medicare Advantage plans, on the other hand, can offer dental care as a supplemental benefit.

Depending on the plan you choose, this can include a wider range of services, including but not limited to routine dental cleanings, bridges, crowns, dentures, fillings, root canals, tooth extractions, and X-rays. Most plans set a cap on how much they would pay for dental care annually.

What Is Medicare Part B Dental?

Unfortunately, Medicare Parts A and B do not coverpreventive dental carelike routine exams, cleanings, root canals, extractions, or X-rays.They will only cover specific dental services required for other medical procedures or conditions.

Medicare Part A is designated as hospital insurance. It covers care you receive when you are admitted to the hospital, care you get in a skilled nursing facility, hospice care, and home health services.

Dental coverage is rare under Part A; however, it may cover certain situations if you are in the hospital for emergency or complicated dental procedures—for example, tooth extractions as part of reconstructive jaw surgery after an accident.

Medicare Part B is optional and will cover your doctor visits, outpatient care, and other routine healthcare needs. It will only cover dental procedures that directly affect your treatment for other medical conditions.

For instance, dental care may be needed to prepare you for surgery, like a kidney transplant or major heart surgery, in which you might be at greater risk for bacteria from the mouth getting into your bloodstream. You may also need teeth removed if a clinician would otherwise have difficulty giving you radiation treatment for head and neck cancers.

The Build Back Better Act, proposed in 2021, planned to add preventive and routine dental coverage to Medicare Part B benefits. This would have been a major financial benefit to seniors on fixed incomes, but the law did not pass through Congress. No new legislation has been proposed since that time.

Low-Cost Dental Options

According to an analysis by the Kaiser Family Foundation, nearly half of Medicare enrollees go without dental coverage. Of those who do have coverage, only 29% get it from a Medicare Advantage plan, and they spent an average of $874 in out-of-pocket costs in 2018. One in five of them spend more than $1,000 each year.

If a Medicare Advantage plan is not the right fit for you or you are unable to afford other dental coverage, you may want to consider some of these low-cost options to get the care you need:

• Charitable organizations: Nonprofit organizations like Authority Health specifically assist older adults in finding affordable dental coverage. Other organizations like the Dental Lifeline Network and Dentistry from the Heart can assist you in finding free care.
• Dental schools: If you live near a dental school or a dental hygienist school, you may be in luck. Dental professionals in training need practice and may offer free or low-cost care in their clinics. To find out if there is a dental school in your area, visit the American Dental Association and the American Dental Hygienists’ Association websites.
• Free or low-cost dental clinics: Some dental clinics offer low-cost services to help people in need. You may want to check out the Association of State and Territorial Dental Directors to locate options in your state.
• Medicaid: More than 12 million Medicare beneficiaries are also dual eligible for Medicaid. While dental coverage will vary for each state, Medicaid could provide a resource for your dental needs.

Alternatively, you may be able to negotiate rates with your dental provider, if your dentist is open to it. In that case, you would be able to set up a payment plan so that you can pay what you can when you can.

Summary

Medicare Parts A and B dental coverage is limited, and many people turn to Medicare Advantage plans for dental benefits. Those benefits vary from plan to plan and are often limited by a cap on spending.

Congress is actively debating expanding Medicare’s dental benefits, but Medicare enrollees may want to look at other low-cost options in the meantime. This may include charitable care, free or low-cost dental clinics, Medicaid, and even care from a local dental school.

A Word From Verywell

Dental health is important to your overall health. Don’t let dental coverage pass you by. You may need to be proactive and look for low-cost options where you live. Many organizations offer coverage for older adults.