For the most part, Original Medicare (Medicare Part A and Part B) does not cover dental care. But there are exceptions to this. Here’s what you need to know about Medicare’s dental coverage and how you can get the dental care you need.
What Does Medicare NOT Cover?
Original Medicare (Medicare Part A and B) does not cover dental care. So assume you’ll pay 100% out-of-pocket for dental procedures like cleanings, tooth fillings, extractions, dentures, and implants.1
There are a few exceptions to this, though. Medicare Part A might cover some dental care if it is related to the reason you’re hospitalized, or if the dental issue is connected to another condition that needs treatment. Original Medicare will also cover dental examinations required before specific surgical procedures.2
Original Medicare Does Not Cover These Forms of Dental Care:
Routine Services
- Cleaning
- Dental exams
- Fillings
- Crowns
- Bridges
Dental Procedures
- Extractions
- Root canal treatments
- Periodontal treatments
Dental Prosthetics
- Dentures
- Dental plates
- Dental implants
- Crowns
What Does Medicare Cover?
Situations When Medicare Covers Treatment
Original Medicare may not cover routine dental care, but there are a few instances where it will meet your needs.
Part A: Hospital Stays
If you’re in the hospital for an injury or illness, Medicare Part A (hospital insurance) may cover dental care you receive during your stay.
For instance, if you fracture your jaw in an accident and are hospitalized, Medicare will cover your jaw reconstruction and the related extractions.3 But Medicare will not cover any follow-up dental care related to the jaw reconstruction that you might need in the future.4
Medicare Part A may also cover the cost of your inpatient care if you need to be hospitalized to have an emergency or complicated dental procedure. This means that Medicare will pay for the cost of your hospitalization (room, board, observation, X-ray, etc.). However, the actual dental service will not be covered. Say you have a clinical condition that requires you to be under observation during a tooth extraction. In this case, the cost of your inpatient stay and observation will be covered, but not the extraction.5
Inpatient care includes treatment you receive at any of these locations:6
- An acute care hospital
- A critical access hospital
- An inpatient rehabilitation facility
- A long term care hospital
Inpatient care you receive as part of mental health care or an eligible research study qualifies too.
Medicare will also pay for preparatory tooth extractions needed before radiation treatment for oral cancer (or other conditions involving tumors in the jaw).
Exam
Medicare will pay for any oral or dental examination you need before a kidney transplant or heart valve replacement. For Part A to cover it, the exam has to be performed by a dentist working for the hospital where you’re being treated.7
Part B: Exam
Medicare Part B will cover required dental or oral examinations before a kidney transplant or heart valve replacement, if the exam is performed by a physician.
What Are My Options for Dental Care?
Almost all adults (96%) over the age of 65 have had a cavity, and another 68% have gum disease.8 This makes it likely that, even if it’s only preventative, you’ll need some form of dental care.
With dental care insurance, there’s a wide range of costs and benefits, depending on a few different factors. Shopping for coverage might seem overwhelming. Here are some basics on the different options available to you.
Stand-alone Plans
You can buy a separate insurance plan that only covers dental care. It’s useful if your current health coverage doesn’t cover dental care, or you want a different kind of dental coverage.
Many stand-alone dental plans require you to go to an in-network dentist for your care. Others may let you use out-of-network dentists for an extra fee.
Costs
Monthly premiums, copayments and annual deductibles vary widely from plan to plan.
Coverage
Coverage also varies widely. Most plans will cover routine dental care, but coverage for more comprehensive services will differ.
Dental Discount Plans
Dental discount plans are not insurance plans. These plans give you discounts on dental services, as long as you go to an in-network dentist.
Costs
With dental discount plans, your cost is a single, upfront annual fee. There are no copays or deductibles. You pay the dentist directly for the service(s) provided, but at a lower price.
Coverage
The discounted services vary from plan to plan.
Conclusion
Aside from special circumstances, Original Medicare does not cover dental care. You can get routine and more comprehensive dental care by buying a stand-alone dental plan or a dental discount plan.
