Many people assume Medicare works like traditional health insurance and includes dental care. Unfortunately, this is not the case. When you join Medicare, you will find that Original Medicare does not cover routine or comprehensive dental care. It only covers limited Medically necessary dental. If you need cleanings, filings, dentures, bridges, or other major dental coverage to maintain proper dental health, then you will need to explore other options.
In this guide, we break down the following:
- Why Dental Coverage Matters for Medicare Beneficiaries
- What Medicare Does and Doesn’t Cover for Dental
- Your Options for Dental Coverage with Medicare
Why is dental coverage important for Medicare Beneficiaries?
It is widely known that oral health can directly affect overall health. As we age, our risk for dental issues increases due to changes in the body, as well as other chronic illnesses or cognitive and physical impairments. This can cause a variety of dental problems, including increased decay from receding gums, gum disease, and tooth loss. John Hopkins Bloomberg School of Health reports that neglected dental, vision, and hearing issues can have cascading effects on physical health. Since oral health plays a role in overall health, proper dental coverage is important to access affordable care.
What Does and Doesn’t Medicare Cover for Dental?
Medicare only covers certain dental services in very limited “Medically Necessary” situations. These are generally for dental services directly related to certain covered medical treatments. So basically, Medicare only covers it if you must get the dental service because it is linked to the treatment you need.
Examples of when Medicare covers dental:
- An oral exam and treatment before a bone marrow, organ or kidney transplant.
- A tooth extraction if needed to treat a mouth infection before chemotherapy.
- Dental exam before and while getting dialysis for End-Stage Renal Disease (ESRD).
Medicare does not cover other dental services that is not medically necessary. This means you are responsible for any routine and comprehensive coverage.
What Medicare Doesn’t cover:
- Routine dental exams, x-rays, and cleanings.
- Fillings, root canals, and tooth extractions.
- Crowns, bridges, and dentures
- And other major dental treatments.
Without proper dental coverage, you are stuck paying out-of-pocket for these dental expenses. Without proper coverage, many people will delay getting needed oral care due to these out-of-pocket costs.
What are your options on Medicare?
Securing dental coverage is important to maintaining overall health as a Medicare beneficiary. If you have Medicare, there are still options to obtain comprehensive dental coverage.
- Standalone Dental Plan
You can purchase a standalone dental plan anytime outside of your Medicare coverage. These plans offer day 1 coverage for a low monthly premium and are available to anyone, regardless of age or Medicare eligibility. There is no underwriting. They typically cover routine care, as well as basic and major dental services.
If you have a Medicare Supplement with Original Medicare, then you still do not have dental coverage. Medicare Supplements help pick up your portion of your Original Medicare costs. They do not include comprehensive dental insurance.
- Medicare Advantage (Part C) Plans
A lower cost option to get dental coverage is through a Medicare Advantage plan. These plans often include extra benefits that Medicare doesn’t offer, including comprehensive dental coverage. It is a lower cost option because most Medicare Advantage plans are low or $0 premium plans. They cover you as soon as you join the plan and typically have higher maximum benefits than the standalone plans.
Need Help Choosing the Right Dental Coverage?
If you want coverage for dental, it is best to compare plans and learn the differences between coverage options when on Medicare. Dental benefits can vary depending on your plan and location. Our licensed agents can help you compare options and explain the extra benefits with Medicare Advantage. We can also show you how coverage works compared to your Medicare Supplement, and help find coverage that fits your needs and budget.
