One of the most common questions Medicare beneficiaries ask online is, “Does Medicare cover dental?” The answer is no. Medicare does not cover dental care, dental procedures, or supplies offered by dentists. Medicare beneficiaries should not expect coverage for dental services such as cleanings, fillings, tooth extractions, dentures, etc.
The only caveat to dental services covered by Medicare is through Medicare Part A (Hospital Insurance). Emergency dental services are covered if you’re hospitalized.
Let’s say you’re in a car accident and suffer oral injuries. Medicare will pay for dental procedures during inpatient care. The dental services must be directly related to the accident or reason for hospitalization and need to be performed during the stay.
Medicare allows dental coverage when beneficiaries are also in:
- Acute Care Hospitals
- Critical Access Hospitals
- Inpatient Rehabilitation Facilities
- Long-Term Care Hospitals
- Inpatient Care for Research Purposes
- Mental Health Care
Does Medicare Part B Cover Dental Services
There’s confusion about Medicare Part B and dental coverage. Medicare Part A covers dental procedures during an emergency and Medicare Part B provides coverage for necessary dental services part of a medical procedure.
Medicare covers dental services when someone needs an oral exam before a kidney transplant or requires extractions before receiving radiation treatment near the mouth.
Medicare coverage does not apply to routine dental care services such as:
Dental Coverage for Seniors
Due to the limitations with dental benefits through the Medicare program, millions of Americans do not receive routine dental services. Preventive dental care can affect overall health, especially as people grow older. This is why it is important for everyone to have a dental insurance plan.
Despite popular belief, Medigap does not provide dental coverage. Medigap is to help pay for Medicare-related expenses for those who are already enrolled in Part A or Part B.
Medicare Advantage Plans – Part C
An independent senior dental plan with Medicare Advantage Plans is one option. Medicare Advantage Plans Part C includes benefits that original Medicare does not, such as coverage for dental.
Medicare Advantage Plans are offered by approved private companies. These private insurance companies must follow Medicare’s rules, including the type of coverage offered, costs, and who can be included in the network of healthcare professionals. While Medicare Advantage Plans allow beneficiaries to seek out of network dentists, pocket costs can be expensive.
In-network dental services include:
- Dental Exams
- Root Canals
- …and other routine dental services.
Medicare Advantage Plans include:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-For-Service (PFFS) Plans
- Special Needs Plans (SNPs)
Copayments, deductibles, and monthly premiums vary with each type of plan. An additional benefit of these plans is that prescription drug coverage (Part D) is included with most of them.
Stand-Alone Dental Plans for Seniors
Medicare supplement insurance or coinsurance can also help with Medicare’s limitations with dental coverage.
Medicaid is an option for seniors who have a low-income, so they cannot afford oral health services out of pocket or through supplemental insurance. Many Medicare beneficiaries apply for Medicaid during enrollment as they discover they cannot pay for other health plans available from Medicare or private insurance companies.
Private Insurance Companies
Private health insurance from companies such as Cigna, Aflac, and Humana can help insurers pay for dental services. Each medical insurance company has its own policies and costs, so researching which ones are the best for your individual needs is important.
Not being able to receive dental coverage from Medicare doesn’t mean you should receive dental care. Affordable options exist for dental coverage. Research the many options, select a plan that is right for you, and be sure to continue taking care of your oral health.