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Medicare Dental: What's covered?

Medicare Dental: What's Covered?

July 5, 2018

Medicare does not cover the routine dental care necessary to keep your smile healthy. Unfortunately, many retirees believe that Medicare does. Perhaps it’s because Medicare does cover some dental procedures. Yes. It’s confusing. So, let’s get into it and clear this thing up.

Here’s a summary of what different Medicare plans cover:

 Part A
"Hospital"
Part B
"Medical"
Part C
"Advantage"
Part D
"Prescription"
  • Inpatient and skilled nursing facility stays
  • Regular doctor visits
  • Hospital and medical coverage through private insurance companies
  • Prescription drug coverage through private insurance companies
  • Home health and hospice care
  • Outpatient medical care like lab tests and physical therapy
  • Helps pay some of the out-of-pocket costs Medicare doesn't
  • Helps pay for medications not covered by traditional Medicare
  • Deductible and coinsurance vary by benefit
  • Some preventive medical services and medical supplies
  • Specific benefits vary by plan
  • Specific benefits and co-shares for medications vary by plan
  • Most retirees don't have to pay a premium for Part A
  • Monthly premium is based on retirement income
  • Monthly premium varies and is paid in addition to other Medicare premiums
  • Monthly premium varies and is paid in addition to other Medicare premiums

This is only a summary of Medicare plan coverages intended to illustrate standard differences between plan designs. Visit Medicare.gov for more comprehensive details and information before selecting your plan.*

Why is Medicare dental coverage so limited?

The Dental Exclusion.1 When deciding on which healthcare items the government plan would cover, Congress included a blanket exclusion of dental services. That means Medicare does not include coverage for routine dental checkups, cleanings, fillings, crowns, implants, dentures, or tooth extractions (in most cases). So, to protect your teeth, you need to get a private dental insurance plan to go along with Medicare.

So, what dental care is covered by Medicare?


There are exceptions to the Dental Exclusion rule. In 1980, congress made a limited exception to cover dental care done in hospitals, in connection with specific inpatient hospital services. The basic principle is that if a dental procedure is required before or after certain medical procedures, Medicare covers that dental procedure.

Covered Medicare dental service include:

  • An oral exam in the hospital before a kidney transplant
  • An oral exam in a rural clinic or Federally Qualified Health Care Center before a heart valve replacement
  • Dental services needed for a radiation treatment for certain jaw-related diseases, like oral cancer
  • Ridge construction (reconstruction of part of the jaw) performed when a facial tumor is removed
  • Surgery to treat fractures of the jaw or face
  • Dental splints and wiring needed after jaw surgery

Medicare also covers some dental-related hospitalizations, including observation during a dental procedure because you have a health-threatening condition. 

In these cases, Medicare will cover the cost of services done by the hospital (room and board, anesthesia, x-rays). It will not cover the professional service fees for the dentist or other physicians (radiologists, anesthesiologists). Those service fees become the responsibility of the patient.

What about Medicare Advantage Plans?


Here’s another exception of sorts. Some Medicare Advantage Plans cover routine dental services, such as checkups or cleanings. This coverage varies widely from plan to plan. If you have a Medicare Advantage Plan, contact your plan to learn about dental services that may be covered.

Do I really need dental coverage?


Yes. Making the right decisions now can keep you healthy and save money down the road. One of the many overall health benefits retirees miss is dental, which isn’t covered by Medicare. 

A good dental plan will cover the dental services needed to keep your smile healthy. These services include dental visits, cleanings, fillings, root canals, crowns, implants and dentures. 

Without dental benefits coverage, the average cost of a preventive dental visit (exam, cleaning, x-ray, and fluoride) is $250-$300. Dental coverage reduces what you pay for serious needs such as crowns and implants, which may cost thousands.

Our Individual and Family plans are a great, affordable way for you to protect your oral health in retirement. Here’s a brief overview of our plans:

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.

Classic Plan
You pay a percentage of the cost for services, including preventive services. It has no annual commitment.

Basic Plan
Exams, cleanings and x-rays are covered at 100% after a $15 copay for office visits. It’s prevention-focused, with limited coverage for other services.

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.

Get Your Quote


*Delta Dental of Washington is independent of the Medicare program and is neither associated with nor endorsed by the Centers for Medicare and Medicaid Services (CMS).
1Section 1862 (a)(12) of the Social Security Act

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