Medicare Dental: What's covered?

Medicare Dental: What's Covered?

October 5, 2020
Originally published July 2018. Updated October 5, 2020

Medicare is a tricky topic to understand – what’s covered, what isn’t, and what even is the difference between Original Medicare and Medicare Advantage?.

And to make things even more complicated, most Medicare plans don’t technically cover dental care.


Over 65? Don’t overlook your dental coverage! Shop our Individual & Family™ plans to find the coverage that’s right for you!


Get Your Quote

For example, Medicare does not cover the routine dental care necessary to keep your smile healthy like dental cleanings, fillings and dentures. This is important because a significant number of retirees and Medicare-eligible Americans believe that it does.

In fact, 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.

So, what does Medicare cover? Let’s break it down – here’s a summary of what the 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 doesn't Medicare cover dental?


Three words: The Dental Exclusion.1

When deciding which healthcare items the government 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’ll need a private dental insurance plan to go along with Medicare.

Just like every rule, though, 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.

Dental procedures covered by Medicare 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;
  • Some dental related hospitalizations, including observation during a dental procedure because you have a life-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 do cover routine dental services, such as checkups or cleanings. If you have a Medicare Advantage Plan, contact your plan provider to learn about dental services that may be covered.


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 & Family™ plans are a great, affordable way for you to protect your oral health in retirement. Here’s a brief overview:


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.

 

Medicare Dental Coverage FAQs


Does Medicare cover dental?

No. 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!


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