Dental coverage is a big cavity in the Medicare program. Most of the time, Medicare won’t pay for your dentist visit.
Medicare’s dental gap is a common and unfair issue. Fortunately, many people with Medicare have found their own solution.
- If you join a Medicare Advantage (Medicare Part C) plan, it probably has some form of dental coverage.
- Medicare Supplement plans may offer discounts on dental care.
- Affordable standalone dental plans for people with Medicare are very popular.
- Other government programs may take your dental needs into account.
Dental Work That’s NOT Covered By Original Medicare (Parts A and B):Medicare’s dental coverage is nothing to smile about. Click To Tweet
Dental work has been excluded from Medicare since the start of the program in the 1960’s. It’s a total exclusion, not just specific procedures.
Medicare does not cover:
- Routine fillings,
- Root canals,
- Crowns and implants.
If you’ve been to the dentist’s office, you know the drill. There are a few ways to get help.
Dental Work That IS Covered By Original Medicare (Parts A and B):
Does Medicare cover dental care at all? If oral work must be performed to address a different health issue – that is, if it is primarily medical and not strictly dental – then Medicare may step in.
Medicare may pay for dental work if:
- Your dental health is so severe that it is a major contributor to hospitalization.
- Your hospitalization is the result of a dental procedure.
- It’s an integral or incidental part of a covered procedure, such as to prep for radiation treatment or remove a tumor
- It may need to be performed at the same time as main procedure.
- It may need to be performed in a Part A inpatient hospital setting.
- Medicare probably won’t cover dental issues that result from the procedure, like need for dentures or tooth replacement.
- It’s part of a jaw injury or similar issue.
- It’s an examination (but not treatment) before a kidney transplant or heart valve replacement, so as to prevent issues during your surgery.
Medicare Advantage May Have Dental
Medicare Advantage plans (Medicare Part C) are different than Original Medicare. They can add important additional benefits, like dental care, to your Medicare coverage.
Sometimes these benefits are automatically on your plan. In other cases, you may have to request them from your insurer.
Medicare Advantage Dental Rules: When you see the dentist on Medicare Advantage, you may have to pay some costs on your own. There will probably be additional rules, like a maximum number of visits or poor coverage for costly procedures. You may have a relatively low maximum annual benefit – enough to get regular cleanings and a set of dentures, but not enough for unlimited dental work.
Expect limited help from your plan even if other medical procedures are well-covered. Medicare Advantage plans must have equal or better coverage as Original Medicare for benefits that are in Part A and Part B. However, Medicare Advantage plans create their own limits on dental coverage.
Medicare Advantage Dentist Networks: Medicare Advantage plans rely on provider networks, like PPOs and HMOs, instead of letting you see any doctor. Dental coverage is no exception. Here’s a typical example of an optional dental plan on Medicare Advantage:
- 100% coverage on in-network routine exams
- 50% coverage on out-of-network routine exams
- Partial coverage for basic procedures and major services
- $1500 maximum annual benefit
Medicare Supplement and Dental
Medicare Supplement can only help you save on Medicare Part A and B care. Since dental work isn’t covered by Original Medicare, your Medicare Supplement plan can’t add on extra benefits like dental coverage.
Some Medigap providers do offer separate discount programs or special offers on their own private coverage as an additional, optional benefit. Look to your Medicare Supplement provider for more details.
How To Get Dental Help Outside of Medicare Programs
Medicare Dental Plans for Seniors: Dental insurance plans are happy to accept people with Medicare. Dental work is less costly than hospitalizations, so dental insurance is known for being very affordable.
Most standalone dental plans work the same way. They’ll have a monthly premium (usually between $25 and $50 per month) along with an annual deductible (usually between $50 and $100 per year).
Typically, preventive care services such as routine check-ups and cleanings are fully covered 1 or 2 times per year, depending on your plan. After you meet your deductible, your plan should pay a percentage of costs towards minor and major services – such as fillings, crowns, and periodontal work.
Your age or health status should not be much of an issue when getting dental coverage. However, premiums for these plans typically increase with age. You can usually join at any time.
Dental Discount Loyalty Plans: Many dental offices accept discount plans instead of insurance. Signing up with a dental discount plan for a minimal cost may give you steep savings on dental work.
Routine Care: Pay out-of-pocket or with a garden variety dental plan. For well under $1 a day, you can enjoy a high level of coverage. Popular brands include Delta Dental, Humana, and AARP.
Dentures and Dental Implants: Without insurance, tooth replacement can be anywhere from $300 per tooth to $1,500 or more for a full set of dentures.
Medicaid and Clinics: Local programs are a vital part of Medicare dental coverage. Over half of states offer Medicaid dental coverage that complements Medicare’s dental gap. Dental schools and health clinics are also experienced in handling Medicare patients. Local programs for seniors are not equipped to handle medical emergencies, but can offer you oral care help.
Employer-Based Insurance: If you’re able to stay on a group health plan when you first join Medicare, you can use this to help pay for dental work. However, the cost of keeping employer-based coverage may not outweigh the cost of paying for dental care on your own.
Medical Tourism: Many seniors find it easy to add a dental visit to an existing foreign trip. Dental procedures are common worldwide, and can be far less demanding to recover from than other types of operations.
Dental health is a significant out-of-pocket expense that you’ll want to plan for once you join Medicare. If you’re starting to think about a Medicare dental plan, join one soon so that it’s ready when you see the dentist.
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