Medicare covers a wide range of services, but some of these services are limited. Dental care is one of them, although taking good care of your teeth and gums is important not only for your mouth, but also for your overall health.
Medicare is a federal program for adults 65 and older and for people who have certain disabilities regardless of age. More than 65 million people are on Medicare.
When you consider that 13% to 17% of people 65 and older are missing all their teeth, you realize that many people may not be getting the dental care they need.
This article will discuss what dental services Medicare covers and how you can get dental care when you need it.
Luis Alvarez/Getty Images
Does Medicare Cover Dental Care?
When it comes to Medicare, you have two main options. You can either enroll in Original Medicare or a Medicare Advantage plan. You can’t have both. Understanding the difference is important when it comes to dental care.
Original Medicare is Medicare Part A and Part B. It is referred to as “original” because these parts of Medicare were created when the Social Security Amendments were first passed in 1965.
In 1997, Medicare Part C was created. It was originally called Medicare+Choice, but its name was changed to Medicare Advantage in 2003.
These plans cover everything that Original Medicare does, but are overseen by insurance companies, not the federal government. Insurance companies are allowed to offer additional services, known as supplemental benefits, beyond what Original Medicare covers.
Original Medicare covers dental care, but in limited circumstances. Medicare Advantage plans, on the other hand, may offer dental care as a supplemental benefit.
Depending on the plan you choose, this can include a wider range of services, including but not limited to regular dental cleanings, bridges, crowns, dentures, fillings, root canals, tooth extractions and x-rays. Most plans set a cap on how much they will pay for dental care each year.
What is Medicare Part B Dental?
Unfortunately, Medicare Parts A and B do not cover preventive dental care, such as routine exams, cleanings, root canals, extractions, or x-rays. They will only cover specific dental services required for other medical procedures or conditions.
Medicare Part A is defined as hospital insurance. It covers care you receive when you are admitted to hospital, care you receive in a skilled nursing facility, hospice care and home health services.
Dental coverage is rare in Part A. However, it may cover some situations if you are in the hospital for emergency or complex dental procedures—for example, tooth extractions as part of a reconstructive jaw surgery after an accident.
Medicare Part B is optional and will cover your doctor’s visits, outpatient care, and other routine health care needs. It will only cover dental procedures that directly affect your treatment for other medical conditions.
For example, you may need dental care to prepare for surgery, such as a kidney transplant or major heart surgery, so you may be at greater risk of getting bacteria from your mouth into your bloodstream. You may also need to have teeth removed if the clinician would otherwise have difficulty giving you radiation therapy for head and neck cancers.
The Inflation Reduction Act (also known as the Build Back Better Act), introduced in 2021, aimed to add preventive and routine dental coverage to Medicare Part B benefits. This would have been a significant financial benefit for seniors on fixed incomes, but the provision for dental coverage was removed before the bill was signed. New legislation was proposed in 2023 but has not yet progressed.
Low cost dental options
More than half of Medicare beneficiaries have chosen a Medicare Advantage plan over Original Medicare. In 2023, 98% of these plans offered dental benefits.
If a Medicare Advantage plan isn’t right for you or you can’t afford other dental coverage, you may want to consider some of these low-cost options to get the care you need:
- Philanthropic organizations: Non-profit organizations like Authority Dentistry Specifically help seniors find affordable dental coverage. Other organizations such as Dental Lifeline Network and Dentistry from the heart can help you find free care.
- Dental schools: If you live near a dental school or dental hygiene school, you may be in luck. Dental professionals in training need practice and can offer free or low-cost care in their clinics. To find out if there is a dental school in your area, visit it American Dental Association and American Dental Hygienists’ Association websites.
- Free or low-cost dental clinics: Some dental clinics offer low-cost services to help people in need. You might want to check it out Association of State and Territory Dental Directors to locate options in your state.
- Medicaid: More than 12 million Medicare beneficiaries are also dual eligible for Medicaid. While dental coverage will vary from state to state, Medicaid could provide a resource for your dental needs.
Alternatively, you may be able to negotiate prices with your dental provider if your dentist is open to it. In this case, you’ll be able to set up a payment plan so you can pay what you can when you can.
Summary
Medicare Parts A and B dental coverage is limited, and many people turn to Medicare Advantage plans for dental benefits. These benefits vary from plan to plan and are often limited by a spending cap.
Dental health is important to your overall health. Don’t let dental coverage pass you by. You may need to be proactive and look for low-cost options where you live. Many organizations offer coverage for older adults. You can also look for charity care, free or low-cost dental clinics, Medicaid, and even care from a local dental school.
