Does Medicare Cover Dental?

It is often said that your oral health is a window into your overall health. Poor dental routine can lead to, or be a sign of, many serious health conditions. Managing and maintaining good oral health is vital to your physical and social wellbeing. But it can be expensive! Many Medicare beneficiaries are in need of dental coverage, so let’s dive straight into the question: Does Medicare cover dental?

Original Medicare Coverage

If you are on Original Medicare, dental is not included in your coverage. Specific hospital or medical treatments that relate to dental services will be covered by Part A or Part B, such as oral treatment before heart operations. Otherwise, Original Medicare will not cover routine dental services. There are also no Medicare dental plans that you can purchase. In most cases, on Original Medicare, you will not have coverage for Dental Plans.

Medicare Advantage

In order to get dental coverage, you will likely need to enroll in a Medicare Advantage plan, otherwise known as Part C. Not all Medicare Advantage Plans offer dental services, but many of them do. Medicare Advantage plans are plans offered by private insurance companies that bundle Parts A and B, often include Part D coverage, and include additional benefits not offered by Original Medicare.

Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans if you stay in network. Other services can be covered to some extent, but may require a copay or co-insurance payment for the service. These costs will be outlined in the plan details, so it’s best to compare plans and find one that offers the best fit for you.

According to a report by KFF, in 2021, 94% of Medicare Advantage enrollees in individual plans have access to some dental coverage with the majority (86%) of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only.

If you are currently enrolled in a Medicare Advantage plan that does not have dental coverage, you may be able to pair your current plan with a dental insurance plan. That usually comes with a premium, but will ultimately save you money from lower out-of-pocket fees.

Also important to note is that while Medicare Advantage plans can often offer dental coverage, there can be limitations and restrictions. These can include:

• Annual benefit caps
• Waiting periods before certain dental services are covered
• Limitations on the types of dental procedures covered
• Networks of dentists that plan members must use to receive the full benefits

Understanding plan limitations can be important to make informed decisions about your dental care within a Medicare Advantage plan.

Whether you choose a Medicare Advantage plan or pair a dental plan with your Medicare Advantage plan, take the time to find a plan that fits your needs and helps protect your dental health. If you are in need of Dental or Vision coverage, Shop Medicare Plans today!