What Dental Services Are Covered by Medicare?
Key Takeaways
- For older adults, routine dental care can prevent common oral health problems like cavities, gum disease, and tooth loss.
- Original Medicare only covers certain dental services when they are considered medically necessary.
- People on Medicare have the option to enroll in either preventive or comprehensive dental insurance from a private insurance carrier.
- Medicare Advantage plans may offer additional benefits, including dental coverage.
Caring for your teeth and gums can become more vital than ever once you’re over 65. Daily brushing and flossing go a long way, but your daily routine alone may not be enough to prevent serious problems as your teeth’s enamel (their protective outer layer) wears away and your gum tissue recedes over time.
When those oral health issues develop or you’re just due for a professional cleaning, insurance may help you access care. However, it’s important to understand what services and procedures are included in your coverage.
Most older Americans have health insurance either through Original Medicare, which is administered by the federal government, or a Medicare Advantage plan from a private insurance carrier. Depending on your health coverage and whether you have a separate dental plan, you could pay very different out-of-pocket costs for needs like exams, cleanings, x-rays, and dentures. Here’s what you need to know about Medicare and oral health.
Oral Health Issues for Older Adults
Regular dental care and hygiene are essential as we age. Dr. Len Brennan, the co-director of the Harvard School of Dental Medicine’s Geriatric Fellowship Program, recommended seeing your dentist twice a year for a check-up, cleaning, and, when necessary, x-rays. He also advised that everyone rinse out their mouth with water before brushing, brush twice a day, and floss at least once daily. For people with arthritis that interferes with brushing thoroughly, he suggested buying a grip aid or an electric toothbrush.
Taking these steps matters because older adults are especially vulnerable to oral health problems. According to the Centers for Disease Control and Prevention (CDC) almost all Americans over 65 have had at least one cavity, and 68% have gum disease. Gum disease, known scientifically as periodontitis, can cause your gums to swell and bleed, and it often leads to losing teeth if left untreated.
In fact, tooth loss is a common issue for this age group. Data from the CDC’s most recent National Health and Nutrition Examination Survey revealed more than 17% of U.S. adults over 65 had lost all their teeth. Tooth loss can result in further health problems, making it a struggle to eat healthy food and communicate with others. Research has even found a connection between losing teeth and an increased risk of dementia.
Dentures make a real difference in health and quality of life for people who are missing teeth, helping them to get proper nutrition, communicate, and stay connected with others. However, purchasing a set is also a big investment if you don’t have significant help from insurance.
According to the University of Arizona College of Medicine’s Center on Aging, a set of dentures typically costs up to $2,000, depending on the complexity of your situation and the materials you choose. And dentures require ongoing care: After your initial fitting, you should follow up with a dentist every six months, when they may need adjustments because of changes in your weight or because they’ve been worn down from use. A set usually lasts five to seven years before it needs to be fully replaced.
Does Medicare Part B Cover Dental?
Medicare Part B, the part of Original Medicare that provides medical insurance, does not include dental insurance. Part B only covers dental services that are considered medically necessary as part of another procedure, such as receiving an exam and dental treatment to lower the chances of infection during surgeries such as a bone marrow or organ transplant or a heart valve replacement.
Medicare Part A, which is hospital insurance, can cover certain dental services during a hospital stay. You might be checked in as an inpatient for dental care either because of an underlying health problem or because the procedure is especially complex and serious.
Outside of these special circumstances, if you’re on Original Medicare, you’ll either need to enroll in a separate dental insurance policy or pay your bills entirely out of pocket.
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What Does Dental Insurance Cover?
Dental coverage may be considered either preventive or comprehensive. Preventive coverage includes basic services like:
- Routine oral exams
- Cleanings
- X-rays
For more extensive benefits, you should look for comprehensive, also referred to as full, dental coverage. When you’re weighing your choices, keep in mind that exactly what’s included and how much you’ll spend depends on the plan you choose.
On any comprehensive dental insurance policy, you will likely need to pay a monthly premium, meet an annual deductible before your policy starts to pay, and cover a portion of the costs of your care as coinsurance. Most dental plans also set an annual limit; if your expenses go above that maximum, you’ll be responsible for the entire difference.
In general, a comprehensive dental insurance policy may cover preventive services, plus basic restorative care like fillings for cavities, tooth extractions, and crowns. Certain plans might offer benefits for major restorative care like:
- Dentures
- Bridges
- Root canals
- Oral surgery
- Periodontics, which is treatment for the structures around teeth to address issues like gum disease and bone loss
Comprehensive dental probably will not pay for any cosmetic procedures, such as tooth whitening, and some policies don’t cover pre-existing conditions.
Medicare Advantage Dental Coverage
Medicare Advantage plans substitute for Medicare Part A and B, and they may include additional benefits like dental and vision coverage. Health policy research firm KFF found that 98% of these plans offered some dental benefits in 2024. However, the details vary greatly based on your specific plan, so you should fully understand what services and procedures are included before enrolling or making an appointment with your dentist.
Like in standalone policies, the dental coverage in Medicare Advantage plans can be either preventive or comprehensive. You may have a variety of plan choices that will affect how much you pay for coinsurance and annual limits on covered services. But an important difference from standalone plans is that many Medicare Advantage plans do not require an additional premium on top of what you pay for health insurance to access dental benefits.
Make sure you’re well informed about your coverage options before choosing a Medicare Advantage plan or a standalone dental plan. Ask a licensed insurance agent how much you can expect to pay out of pocket for any care that you’re likely to need.
Sources
The senior’s guide to dental care. Harvard Health Publishing.
Oral Health Tips for Adults. CDC.
Tooth Loss in Seniors. NIH.
Elder Care. University of Arizona Center on Aging.