Medicare and Dental Coverage

Dental expenses have always been excluded from Original Medicare coverage. In fact, dental care is still not covered by Original Medicare today. However, there are a few exceptions that allow dental coverage through Medicare.

Originally, all dental services (not just routine dental care) were part of the Medicare exclusion. A Medicare amendment in 1980 created an exception to the rule, which said that inpatient hospital services, where hospitalization was necessary due to a dental procedure, would be covered by Medicare. That means, if you're admitted to the hospital for a necessary dental procedure or dental emergency, the costs of the hospitalization would be covered under Medicare Part A even if the dental service itself is not covered by Original Medicare.

There are a few other rare cases where Original Medicare covers certain dental care. For example, Medicare covers surgery to reconstruct a damaged jaw due to an accident. Medicare also covers dental exams before undergoing complicated surgeries or treatments that are covered by Medicare, but not otherwise related to dental care. In that case, only the dental exam is covered by Medicare, not any subsequent dental treatment that may result from the dental exam. If the dental exam was provided by a physician, Medicare Part B would cover the cost as a medical expense, not a dental expense. If it was provided in a hospital, Medicare Part A would cover it as part of the hospital costs.

These costs are subject to your normal Medicare coinsurance and Medicare deductible. Also, Medicare only covers the costs that are approved by Medicare.

How can Medicare Recipients get Dental Insurance?

Some Medicare Advantage (Medicare Part C) plans include dental benefits. Medicare Advantage plans must cover as much or more benefits offered by Medicare Part A and Medicare Part B. But, unlike Original Medicare, Medicare Advantage plan benefits vary. Not all Medicare Advantage plans include dental coverage, so shop around. Medicare Advantage plans are sold through private insurers.

You can also get private dental insurance either through an agent or an employer. Compare different types of dental plans to fit your dental needs. Dental plans can vary in terms of what's covered, how much you pay each month, and how much you pay out of pocket for dental exams and dental procedures.

Some dental insurance plans have network restrictions. With Medicare, you must see doctors who accept Medicare assignments. Similarly, with a network-type dental plan, you must see dental care professionals that participate in that dental plan's network. This can be an advantage if staying in the dental network keeps your own share of the costs down under the terms of the plan.

Another option that may be available in your area is to pay for membership into a dental discount program. You can do this even if you have Original Medicare. Typically, you pay a once-a-year fee to get year-round savings on your dental care. With a dental discount program, you're not "insured". That means the company does not pay dental benefits like dental insurance or Medicare. Instead, you pay a discounted price for your dental care at participating dental care providers. Many dental practices now offer their own dental discount program.

Keep in mind that dental discount programs and network-style dental insurance plans are often found in areas where the population is significant enough to create a network of dental care providers who can offer lower rates for those members. That means they aren't available everywhere. You need to shop around for all your dental options. Be sure to compare dental plans and dental programs so you can get what works best with your typical dental needs.

Medicare has neither reviewed nor endorsed this information.