Medicare and Dental Coverage
Medicare’s dental coverage is limited. If you have Original Medicare (Part A and Part B), you won’t be covered for most dental services and supplies, including:
- Dental exams
- Routine cleanings
- Fillings
- Tooth extractions
- Dentures and dental implants
Medicare Part A (hospital insurance) does cover limited dental services if you receive them in a hospital, and if they’re necessary to perform a covered, non-dental procedure or service. For example, Part A might pay for a tooth extraction in preparation of radiation treatment on a patient’s jaw. However, Medicare will not cover follow-up dental treatment after the primary condition has been treated.
Seniors and oral health
It can be easy for seniors to neglect basic oral hygiene as they get older, especially as conditions like arthritis can make brushing or flossing more difficult. However, older adults are especially at risk for oral health problems like:
- Cavities
- Tooth loss
- Tooth sensitivity
- Oral cancer
- Root decay
- Gum disease
- Thrush
- Dry mouth
Risk for certain conditions, including gum disease and oral cancer, increases with age. Oral health is often strongly connected with overall well-being and should be maintained with daily brushing and flossing, as well as regular cleanings and oral exams. Early signs of other conditions, such as diabetes and cancer, are often first identified at the dentist’s office.
How to get Medicare dental coverage
Because Original Medicare (Part A and Part B)dental coverage is very limited, you will generally have to pay for the full cost of most dental services out-of-pocket. However, there are other coverage options if you want help paying for dental costs.
Many states have dental clinics available that offer dental care for free or a reduced cost. Check with your local hospital or Medicaid office to see if there is one located near you.
You may also be able to receive dental coverage through a private Medicare Advantage plan. All Medicare Advantage plans are required to offer at least the same level of coverage as Part A and Part B and may offer extra benefits, including dental coverage. Some plans allow you to add on optional dental coverage for an additional premium.
Medicare Advantage plans vary in the specific dental coverage they offer. Most will cover basic preventive services, such as oral exams, cleanings, X-rays, and fillings, along with major dental services, such as extractions, crowns, and oral surgery. These types of services can easily run in the thousands of dollars if you pay out-of-pocket.
Give the following information to your Medicare Patients. Let them know you can help
Check with the individual Medicare Advantage plan to see what dental services and supplies are included.
To find Medicare Advantage plans in your area that provide dental coverage, simply compare plans at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), 24 hours a day, seven days a week.