Does Medicare Cover Dental Crowns?
Key Takeaways
- Original Medicare (Parts A and B) does not cover dental crowns, but some Medicare Advantage plans may offer dental benefits, including coverage for crowns.
- Dental crowns are used to repair chipped, fractured, or broken teeth that need more support than routine fillings.
- Medicare Advantage plans vary in their dental coverage, so it is important to carefully compare options, especially if comprehensive care like dental crowns is a priority.
- Other options for dental coverage include stand-alone dental insurance, Medicaid, PACE programs, and community health programs, though availability and benefits vary by location and eligibility.
Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), does not cover dental crowns. However, Medicare beneficiaries have other options to obtain dental crown coverage, such as a Medicare Advantage plan.
Medicare Advantage plans may offer different levels of dental coverage, or no coverage at all, so it is important to verify plan benefits before enrolling if dental coverage is a priority for you. However, a number of Medicare Advantage plans offer additional benefits that may include the dental coverage that Original Medicare lacks.
Additional Benefits Fulfill Coverage Needs
As of June 2024, nearly 67.5 million people are enrolled in Medicare, with 89.5% of them aged 65 or older. As we age, the risk of developing tooth or root decay increases, weakening teeth and making them prone to cracks or breaks. To prevent tooth loss, dental crowns can provide crucial support when a filling isn’t enough, helping preserve natural teeth.
For Medicare beneficiaries focused on keeping up with their oral health, a Medicare Advantage plan may be a smart choice. About 98% of Medicare Advantage members receive dental benefits, which are typically divided into preventive, basic, or comprehensive care. Since dental crowns are usually classified as major restorative services, you’ll likely need a plan with comprehensive dental coverage to get the support you need.
How Medicare Advantage Covers Dental Crowns
Although Original Medicare does not cover dental crowns, there are situations where other dental care services may be covered. In some cases, if the reason for the dental service is related to a covered medical condition, Medicare may cover that service. Common examples include:
- Oral exams if needed prior to heart valve replacements and transplants.
- Procedures that treat an infection before receiving chemotherapy or other cancer services, such as tooth extractions.
- Dental services used to address complications of certain cancer treatments, such as tooth extractions and root canals.
Medicare Advantage, on the other hand, may offer broader dental coverage. When a beneficiary enrolls into a Medicare Advantage plan, it replaces their Original Medicare to provide hospital and medical coverage under one network plan, like an HMO or PPO.
A number of Medicare Advantage plans offer coverage that exceeds Original Medicare’s limitations, such as routine dental care, vision services, and drug coverage. If your Medicare Advantage plans offers comprehensive dental benefits, then medically necessary dental crowns would likely be covered. Specific benefits vary by carrier and location, so be sure to ask specifically about dental crown coverage if this is a health priority for you.
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How Much Dental Crowns Costs with Medicare
Depending on the materials used, crowns can cost anywhere from $500-$3,500 without dental insurance. Porcelain and ceramic crowns are more expensive, but offer better durability and a more natural look. Metal and stainless steel crowns are the most cost effective, but also offer less durability over time and do not blend in with your natural teeth.
Because dental crowns are rarely a medical necessity related to other covered services, those with Original Medicare can expect to pay fully out of pocket for dental crowns.
If your Medicare Advantage plan offers comprehensive dental benefits that includes coverage for dental crowns, your costs would likely include:
- Monthly plan premium, plus your Part B premium. The premium is what you pay each month to keep your plan active. For most Medicare Advantage plans, you must continue to pay your Part B premium in addition to the plan premium.
- Your plan’s deductible. This is the amount you must pay out of pocket for covered services each year before your plan begins to cover its portion of costs.
- Your plan’s copayments and coinsurance. These costs are your portion of the cost sharing for your Medicare Advantage plan. Copayments are usually paid for each service, such as a flat fee to see your doctor. Coinsurance is the percentage of the total service cost you would pay, while your plan covers the remaining amount.
- Any costs that exceed your plan’s coverage limits. If your doctor charges more than the Medicare-approved amount for a service, you may incur additional out-of-pocket costs.
Other Options for Getting Dental Crown Coverage
- Stand-alone dental insurance: This is a network insurance plan offered by private insurance companies that specifically covers dental services. Much like traditional health insurance, there is a monthly premium, plus applicable deductibles, copayments, and coinsurances for covered services. These types of plans also feature benefit maximums, which is the most the insurer will pay on covered services throughout the year. Any costs that exceed this must be paid out of pocket.
- Medicaid: Medicaid is a joint program run by the federal government and the state. It provides affordable health coverage to low-income families, disabled individuals, and others who meet qualification criteria. Eligibility guidelines and coverage vary by state, but select dental services are covered by Medicaid in some states.
- Program of All-inclusive Care for the Elderly (PACE): PACE helps Medicare and Medicaid beneficiaries who live in states where the program is available under Medicaid. This program provides coordinated care and coverage for medically necessary services, such as dental care. However, specific benefits vary by area.
- Community health programs: Public programs serve the community by offering a variety of health services, usually at a deeply discounted rate or for free. Local dental schools and clinics may have community programs where patients may receive necessary dental care such as dental crowns.
Putting It All Together
Dental crowns are not covered by Original Medicare, but there are other ways to get this coverage. Medicare Advantage plans and stand-alone dental insurance are available in most areas, but benefits can vary greatly depending on your location and insurance carrier. Medicaid and community health programs may be available if you meet certain guidelines. For an in-depth look at all your dental coverage options, it can be helpful to speak with a licensed insurance agent.Sources
Dental services. Medicare.gov
PACE. Medicare.gov
Dental Crowns: Preserving Damaged Teeth. Consumer Guide to Dentistry.
Dental Crown To Replace Teeth: Costs, Materials, Types, and More. Dentaly.