Medicare Dental Coverage - Does Medicare Cover Dental?
Over 65? Don’t overlook dental benefits! Shop our Individual and Family™ plans to find the coverage that’s right for you!
Medicare is a tricky topic to understand. What’s covered? What isn't? What's the difference between Original Medicare and Medicare Advantage?
According to a 2018 survey conducted by Nationwide and The Harris Poll, more than 70 percent of Medicare-eligible Americans wish they understood their coverage better.
Does Medicare Cover Dental?
It depends. Most Medicare plans don’t technically cover dental care.
For example, contrary to the what many retirees and Medicare-eligible Americans may think, Original Medicare doesn't cover the routine dental care necessary to keep your smile healthy like: dental checkups, basic dental cleanings, fillings, crowns, implants, dentures and tooth extractions.
Why doesn't Medicare cover dental care?
Three words: The Dental Exclusion.
When deciding which healthcare items the government would cover, Congress included a blanket exclusion of dental services. So, to protect your teeth, you’ll need a private dental insurance plan to go along with Medicare.
What Dental Services Are Covered By Medicare?
Just like every rule, there are exceptions to the Dental Exclusion.
In 1980, congress made an exception to cover dental procedures done in hospitals that were conducted alongside specific hospital services. Basically, if a dental procedure is required before or after certain medical procedures, like surgeries or transplants, in order to then have a medical procedure done, Medicare will cover it.
Medicare may include:
- Certain dental services you get when you're admitted as a hospital inpatient for your dental procedure, either because of your underlying medical condition or the severity of the procedure.
- Specific inpatient or outpatient dental services directly related to certain covered medical treatments. In these cases, you must get the dental service because it’s linked to the success of the medical treatment you need, like:
- Dental services needed for a radiation treatment for certain jaw-related diseases, like oral cancer;
- An oral exam and dental treatment before you get a heart valve replacement or a bone marrow, organ, or kidney transplant.
- A procedure (like a tooth extraction) to treat a mouth infection before you get cancer treatment services like chemotherapy.
- Treatment for a complication you experience while getting head and neck cancer treatment services.
Do I really need dental coverage?
Yes. If you’re over 65, practicing good oral hygiene is especially important and making the right decisions now can keep you healthy and save money down the road.
A good dental plan will cover the dental services needed to keep your smile healthy. These include dental visits, cleanings, fillings, crowns, implants and dentures.
Without dental coverage, the average cost of a preventive dental visit (exam, cleaning, x-ray, and fluoride) is $250-$300. A good dental plan will help reduce your cost for things such as crowns, implants, and dentures.
Our Individual and Family™ dental plans recommended for seniors and retirees are a great, affordable way for you to protect your oral health in retirement. Here’s a brief overview:
Optimum Plan
Cost-sharing for cosmetic teeth whitening and veneers. Highest maximum and coverage on major procedures.
Premium Plan
Similar to traditional group plans, members pay a percentage of the cost for services and the plan pays the rest. This is our most comprehensive coverage; preventive services are covered at 100% and you get a $2,000 annual maximum.
Enhanced Plan
Similar to the Premium Plan but has a $1,000 annual maximum.
Clear Plan
Members pay fixed copays for dental services. There are also no deductibles, no waiting periods, and no annual dollar maximums.
The list above is very high-level information. We recommend you always review plan details and get a quote before you purchase a dental insurance plan. Here are some tips to help you choose the one that’s right for your smile.
Medicare Dental Coverage FAQs
Does Original Medicare cover dental?
No. Original Medicare only covers dental if a dental procedure is required before or after a medical procedure.
Does Medicare Advantage cover dental?
Maybe, it depends on your specific plan. Talk to your plan provider to find out more.
Can I get dental coverage?
Yes! We have a variety of plans for retirees and Medicare-eligible Americans. Shop our Individual & Family™ plans to find the coverage that’s right for you!
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