When does Medicare cover dental and when it doesn’t?

Medicare helps to cover the costs of medical expenses for people 65 and older. And people with certain disabilities under the age of 65. Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. However, it doesn’t cover benefits like eye exams, most dental care, and routine exams.

Medicare Advantage plans (Part C) on the other hand, often include dental coverage. It’s important those eligible for Medicare understand what a Medicare plan does and doesn’t cover.

Does Original Medicare cover dental?

Original Medicare includes Part A and Part B benefits. Part A benefits help cover inpatient health care. Part B helps cover outpatient medical services. Original Medicare Part A and Part B benefits do not include dental benefits.

But in certain circumstances, a person with Original Medicare may get coverage for medically necessary dental procedures. For example, a member falls and suffers a fractured jaw. Original Medicare may cover any resulting tooth damage. Original Medicare may also cover dental services if they’re part of treatment for a covered illness like oral cancer.

For medically necessary dental procedures, coverage falls under Part A benefits when the member receives inpatient care. Coverage falls under Part B benefits when the member receives outpatient care.

Keep in mind, Original Medicare does not cover routine dental procedures like teeth cleaning, extractions, retainers, or dentures.

What Original Medicare may cover

• Certain dental services when a member is in the hospital as an inpatient for their dental procedure due to an underlying medical condition. Or due to the severity of the procedure.
• Certain inpatient or outpatient dental services related to specific covered medical treatments. In these cases, the member must get the dental service because it’s linked to the success of the medical treatment they need, like:
  • An oral exam and dental treatment before getting a heart valve replacement. Or a bone marrow, organ, or kidney transplant.
  • A procedure (like a tooth extraction) to treat a mouth infection before the member gets cancer treatment services like chemotherapy.
  • Treatment for a complication during head and neck cancer treatment services.

Costs in Original Medicare are as follows.

Members pay 100% for non-covered services, including most dental services.

For Part A-covered inpatient hospital says, the member pays the current hospital deductible for each benefit period.

For Part B-covered dental services, the member pays 20% of the Medicare-approved amount after paying the Part B deductible. If the member gets the covered service in an outpatient hospital or other facility, they’ll also pay a copayment to the facility.

Why does Medicare not cover dental?

Although older adults require dental health services, Original Medicare does not cover dental health because they’re not deemed medically necessary.

Medicare and private health insurance companies typically view dental care and medical care as separate.

Does Medicare Advantage cover dental?

A Medicare Advantage plan, may offer coverage for dental services, including routine treatments like dental cleaning, extractions, fillings, and dentures. Keep in mind though, not all Medicare Advantage plans offer the same added benefits. All benefits differ depending on the plan and insurer.

Medicare Advantage plans include all Part A and Part B benefits offered by Original Medicare. They may also offer “added” benefits not included in Original Medicare, like dental. Always review a Medicare Advantage plan’s dental benefit. Know what dental services the plan covers, copayments, and applicable limits. Remember, not all Medicare Advantage plans include dental coverage.

Does Medicare Supplement Insurance (Medigap) cover dental?

Private insurers offer Medicare Supplement Insurance plans or Medigap policies to supplement Original Medicare. Medigap plans only help cover out-of-pocket costs in Original Medicare like deductibles, coinsurance, and copays. Medigap policies do not include dental coverage.

Does Medicare Prescription Drug (Part D) cover dental?

Medicare Part D benefits cover prescription drugs. Medicare prescription plans do not include dental care. If coverage for dental services is a concern, consider a Medicare Advantage plan. Or opt for a stand-alone dental plan from private providers to go along with Original Medicare.

Does Medicare cover dental implants?

Members of Original Medicare cannot claim reimbursement for dental implants because they’re not deemed medically necessary. Dental implants are permanent solutions in place of dentures for those who lost teeth.

Original Medicare does not cover dental implants. Those who require dental implants can either opt for a Medicare Advantage plan or a stand-alone dental insurance plan. Be sure to check policies before enrolling in one. Verify with providers if they include dental implants and any applicable limits.

Does Medicare cover dental surgery?

Original Medicare may cover dental surgery if it is part of treatment for a covered illness. Part A benefits cover dental surgery if it’s an in-patient procedure. Part B benefits cover it if it’s an outpatient procedure.

The member’s physician must deem the surgical procedure medically necessary for Original Medicare to cover it. Instances where Original Medicare covers dental surgery includes the following. 

• Dental surgery before organ transplant to reduce the risk of infection.
• Dental surgery following traumatic injury to the jaw.
• Dental surgery as part of treatment for oral cancer or a tumor.

Does Medicare cover dental crowns?

Crowns restore, protect, or cover damaged teeth. Original Medicare does not cover crowns since they don’t deem them medically necessary. A Medicare Advantage plan may cover dental crowns. But it depends on the provider and type of Medicare Advantage a member has.

Does Medicare cover dental infections?

Original Medicare only covers treatment for dental infections if it’s deemed medically necessary for the treatment of a medical condition. For instance, the member needs radiation treatment. The physician may deem it necessary to treat an oral infection to reduce the risk of side effects.

Many Medicare Advantage plans include coverage for dental services. They may also cover dental infections.

Does Medicare cover dental cleaning?

Original Medicare does not cover dental cleaning or any other routine dental procedures. However, if a person has a Medicare Advantage plan, their plan may cover routine services like teeth cleaning, extractions, and retainers. Be sure and check with the Medicare Advantage plan to see if covers dental cleaning.

Does Medicare cover dental extractions?

Original Medicare does not cover dental extractions unless they’re deemed medically necessary as part of treatment for a covered medical condition. For instance, an individual has a traumatic injury to the jaw. Original Medicare may cover the extraction if the doctor deems it a necessary part of their treatment.

Medicare Advantage plans with dental coverage may cover dental extractions. But it depends on the provider and plan type.

Does Medicare cover dental bridges?

Original Medicare does not cover dental bridges. A Medicare Advantage plan may cover this type of treatment.

Does Original Medicare cover dental bone grafts?

Original Medicare does not cover dental bone grafts. Original Medicare only covers dental services that are part of treatment for a covered medical condition. A Medicare Advantage plan may include coverage for dental bone grafts.

Reminders

Contact your plan directly and ask if your current Medicare Advantage (Part C) plan includes any dental benefits. If you’re looking for a Medicare Advantage plan to help pay for these benefits, use an online Medicare plan finder such as the one on Attain Health. This type of portal allows you to browse for plans that meet your needs without having to give your phone number for a licensed insurance agent to call you back. While searching new plans, check what added benefits each Medicare Advantage plan includes.