Medicare and Dental Coverage

 

Aside from a few exceptions, dental expenses are excluded from Original Medicare, Part A and Part B, coverage. This includes most routine dental services and items such as:

  • Oral exams
  • Routine cleanings
  • Fillings
  • Crowns
  • Bridges
  • Extractions
  • Dental implants
  • Dental appliances, including dentures, retainers, and dental plates

However, in certain rare situations, Medicare does cover certain dental procedures. The main exception concerns inpatient hospital services where hospitalization is necessary due to a dental procedure. For example, if you’re admitted to the hospital for a 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 instances where Original Medicare may cover dental care, but these are best considered rare occurrences and not usual treatment. Examples include, but are not limited to:

  • You have a health condition where certain dental services require you to be hospitalized to receive the service.
  • A dental procedure is needed as an essential part of, or in preparation for, another covered medical procedure. For example, Medicare may cover extractions needed to prepare your jaw for radiation if you’re undergoing cancer treatment. Please note that Medicare doesn’t cover follow-up dental services you may need once the covered procedure has already been performed.
  • You need surgery to reconstruct a damaged jaw due to an accident.
  • You need a dental exam before undergoing complicated surgeries or treatments that are covered by Medicare, but are otherwise unrelated to dental care. For example, Medicare may cover oral exams that are part of a pre-op exam before a kidney transplant surgery or heart valve replacement procedure.

If a physician provides the dental exam in an outpatient setting, Medicare Part B  covers the cost as a medical expense, not as a dental expense. If it’s provided in a hospital while you’re an inpatient, Medicare Part A covers it as part of the hospital costs.

These costs are subject to your normal Medicare cost sharing, which may include coinsurance and/or copayments and the Medicare deductible. Of course, Medicare will cover only the costs that it approves.

How can Medicare beneficiaries get dental insurance?

Because Medicare Advantage plans are required to provide at least the same amount of coverage as Original Medicare (except for hospice care, which is still covered by Part A), these plans also cover the procedures mentioned above. Some Medicare Advantage plans may include more comprehensive dental coverage. If dental benefits are included, this may include routine dental services not covered under Original Medicare. Benefits vary from plan to plan, so check with the specific Medicare Advantage plan if you’re interested in learning more about dental coverage. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare.

Are there dental insurance options outside of Medicare?

If you choose to remain covered by Original Medicare or can’t find a Medicare Advantage plan in your area that offers dental benefits, you may have dental coverage options outside of the Medicare program. For example, you can get private dental insurance either through a licensed insurance broker like eHealth or an employer. Compare the different types of dental plans in your area and weigh your needs against them. The costs of a dental plan can vary by plan and provider.

Some dental insurance plans have network restrictions, similar to the way that Medicare has you visit doctors and health-care providers who accept Medicare assignment. With a network-type dental plan, you must see professionals who reside in the dental plan’s network.

There are other options as well. If you have limited income and qualify for state assistance, some Medicaid programs include dental coverage. Medicaid programs are run at the state level, and dental coverage is an optional benefit under federal guidelines, meaning that states may choose whether or not to include this coverage. If you’re eligible for Medicaid, contact your state’s Medicaid department for more information on whether help with dental costs is available.

Another option, if it’s available in your area, is that you may be able to join a dental discount program, even if you have Original Medicare. Typically, you pay a once-a-year fee for savings on dental care. With a dental discount program, you’re not “insured,” so the company doesn’t pay dental benefits, as dental insurance does. Instead, you pay a discounted price for your dental care at participating dental-care providers.

Dental discount programs and network-style dental insurance plans are often found in areas where the population is large 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 may want 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.

Do you have questions about your dental coverage options as a Medicare beneficiary? If you’d like help finding a Medicare Advantage plan option that may include dental benefits beyond Original Medicare, feel free to contact an eHealth licensed insurance agent today to get personalized assistance.

To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
  • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
    • Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.

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