Does Medicare Cover Dental?
Dental health is an important part of your overall well-being, no matter your age or health status. Dental professionals recommend getting a check-up every six months — or even more frequently depending on your gum health. But regular dental visits can cost $100 or more depending on whether you need X-rays and other preventive services.
If you’re on Medicare, you may want to know whether you’ll be covered for routine dental care, such as X-rays and cleanings, or for medical devices such as dentures.
The short answer is that Original Medicare doesn’t cover dental services. However, you may be covered under certain limited circumstances if a dental procedure is medically necessary and related other health care needs that are covered by Medicare.
Let’s take a look at some of the situations in which Medicare will cover dental services, and how you can find alternative coverage if you require it.
Does Medicare Cover Dental?
Original Medicare (Parts A & B) covers hospital care and outpatient services such as doctor’s visits and lab tests. It doesn’t cover vision, dental, or hearing care, except in very limited circumstances when related to other health care services.
This is unfortunate because oral health is closely linked to general health. It’s especially important for seniors who may take medications that impact saliva flow, which regulates the level of bacteria in the mouth that are associated with gum disease. In the long-term, a regular dental care routine can help to reduce the risk of developing cardiovascular disease, pneumonia, endocarditis, and other medical conditions. This is because bacteria that live in the mouth can spread to other parts of the body.
While you can pay for dental care out-of-pocket, you do have some alternative options for coverage that we’ll look at later in this article. But first, what are some situations in which Original Medicare will pay for dental care under Part A or Part B coverage?
Are There Situations In Which Dental Services Can Be Covered?
If you only have Original Medicare and don’t have alternative dental coverage, there are still some situations in which Medicare will pay for your dental services. However, this is usually only the case when dental care is linked to another health care need, so it won’t apply to routine dental services, such as cleanings and X-rays.
One situation is when you need emergency dental care while in the hospital for an illness or injury. For example, if you need jaw surgery after an accident or in order to prepare you for radiation treatments. In these cases, you would be covered under Medicare Part A, which covers hospital care and emergency inpatient services.
If you’re having heart or kidney surgery, then you may be covered for a dental exam before your surgery to check on your oral health. This would be covered by Part A if it takes place in the hospital, but it could be covered under Part B if it’s provided by your primary care physician in an outpatient facility.
You may need to have the service take place at the same time and be performed by the same person in order for it to be covered by Medicare.
What You Pay
The amount that you have to pay for services depends on what part of Medicare it falls under. If your service is not covered by Original Medicare, then you’ll have to pay for the full cost out of pocket. If it is, then it may be covered either by Part A or Part B.
Part A covers hospital care and has a $1,364 deductible. This means that you coverage will only start once you’ve paid the deductible for each benefit period. After that, you’ll be covered for 100% of costs for the first 60 days, and you’ll pay $341 per day coinsurance for days 61-90 and $682 per day beyond that.
So how much you pay for an emergency dental procedure while you’re in the hospital depends on when it takes place and may be fully covered once you meet your deductible.
If your service is provided by a primary care doctor, then it will fall under Medicare Part B. This coverage has a $185 annual deductible and a 20% copay. So once you’ve met your deductible for the year, you’ll pay 20% of any covered dental care services.
Finally, if you have Medicare Advantage, your costs will vary depending on your policy. Since the deductible and copay can vary from plan to plan, you’ll have to ask your doctor or insurer to confirm how much you’ll be expected to pay for your services. We’ll look at Medicare Advantage policies more closely later in the article.
Dental Coverage Under Part A
Most of the situations in which Original Medicare covers dental services will fall under Part A rather than Part B. These are primarily emergency situations, such as when you need jaw reconstruction while in the hospital after surgery. You won’t be covered for everyday dental health care needs, even while you’re in the hospital.
What about situations in which you’re hospitalized for a dental procedure, such as an intensive dental surgery that requires an overnight stay? You might think that Medicare would cover it under Part A, but in fact, it won’t: you’ll only be covered for the hospital stay, not for the dental procedure.
It can get a little confusing when your dental procedures overlap and fall under different categories of care. It’s important to always ask your doctor or dentist how the procedure will be reported to Medicare so you can accurately estimate your expenses. You’ll have to pay out of pocket for anything that Medicare doesn’t cover.
Medicare Advantage Part C and Dental
If you don’t want to pay for dental care out-of-pocket, then you may be able to get dental coverage by enrolling in a Medicare Advantage plan. While you’ll have to pay a monthly premium for a Medicare Advantage policy, they typically include more comprehensive coverage that Parts A and B, and may cover vision, hearing, and dental services.
Medicare Advantage policies vary widely depending on your location and insurer, so it’s important to make sure that you choose a plan that covers the services you have in mind. Before you enroll in Medicare Advantage, find out whether it covers preventive care, such as regular cleanings and X-rays, as well as emergency care.
The most comprehensive plans will cover root canals, fillings, dentures, and more, but these may have higher premiums or deductibles. If you aren’t sure what your Medicare Advantage plan covers, ask your insurer before going to see your dentist.
You may still have to pay some out-of-pocket fees for these services, such as a copay, and there may be an annual limit to how much your policy will pay for. But even a plan with an annual limit or coverage restrictions might still be worth it in the long run. After all, a full set of dentures alone can cost thousands of dollars.
If you’re concerned about your oral health and want to be proactive in taking care of your teeth, then getting a Medicare Advantage policy may a good option. Make sure that your policy will cover you both for routine preventive care and emergency dental services.
Other Dental Insurance Options
Another alternative is to purchase a standalone dental plan, such as those offered by AARP. This would allow you to keep your Original Medicare coverage for most of your health care needs, while still having comprehensive dental coverage. These plans are offered by private insurers and are entirely separate from your Medicare policy.
You could also consider a dental discount plan, which is not insurance coverage, but may provide substantial discounts to your out-of-pocket costs. You’ll still have to pay for dental services but can get anywhere from a 10% to 60% discount when you go to a dentist that is in your discount plan’s referral network.
Finally, if you’re low-income, you may be eligible for Medicaid, which includes dental coverage for adults in some states. For example, in Nevada, adults with Medicaid are covered for emergency extractions and exams, but not preventive care. Medicaid may even cover dentures in some circumstances.
Finding the right coverage for your dental health care needs can be complicated. You might choose to pay for dental care out-of-pocket, but these costs can add up. And of course, it’s not a good idea to wait for an emergency to get a dental health exam!
If you need health figuring out whether your current plan includes dental coverage,
Get the Coverage You Need
or you want to switch to a plan that does, reach out to the team at the Medicare Store. We have experience working with Medicare policies of all kinds, and can quickly assess whether the plan you have is the right one for you.
Just fill out the contact form, and one of our licensed insurance agents will get back to you to schedule a phone call or in-person consultation to discuss your options.