Even though Original Medicare does cover preventative services like routine blood work and screenings, coverage does not include routine dental care. Medicare Part A & Part B only cover medically necessary services performed at the hospital or during a doctor’s visit. Unfortunately, a visit to your dentist is not categorized as a primary or specialist doctor’s visit under Part B.
Pro Tip: While Medicare won’t cover routine dental care, private insurance is often cheap. To learn more, check out our selections for the best dental insurance for seniors.
Medicare Dental Coverage
Part A & Part B do not cover dental cleanings, dentures, extractions, fillings, or any other services that fall under routine dental care. Services performed at a dentist’s office are considered outside of the scope of hospital or doctor services.
According to KFF, 65 percent of Medicare beneficiaries do not have dental coverage, 19 percent spent more than $1,000 on out-of-pocket costs for dental care, and 49 percent have not been to the dentist within the past 12 months.
However, if the service is part of another covered service that’s considered medically necessary, you do have coverage. Which part of Medicare covers the service depends on if it’s performed in an inpatient or outpatient setting.
What Dental Services Are Covered by Medicare?
Medicare does include limited coverage for dental care considered medically necessary in order to protect your overall health.
Part A will cover the costs of some dental services received while you’re at the hospital. If you need to have an emergency dental procedure, it will be covered under Part A as long as it’s performed in an inpatient setting.
If you have a condition that is threatening your overall health where a dental-related hospitalization is required, Medicare will cover the hospital observation costs during that dental procedure.
Part B will cover the cost of dental services performed in an outpatient setting that are considered part of a procedure that would normally be covered.
Please note: Medicare will cover the initial costs of the above-mentioned dental services, but you will not have coverage for any follow-up care once the underlying condition has been treated.
Some procedures include:
Any exams performed in outpatient settings that are required prior to an oral surgery
Any exams performed in outpatient settings that are required prior to a kidney transplant
An oral exam that is required prior to a heart valve replacement
Any reconstructive jaw surgery after an accident
Any extractions necessary that are done in preparation of radiation treatment involving your jaw
Does Medicare Cover Dental Implants?
The average cost of dental implants ranges from anywhere between $3,000-$5,000. However, there are additional costs that come with dental implants. These additional costs can range between $1,300-$2,500. Since dental implants fall under routine care, the costs will not be covered by Medicare.
Does Medicare Cover Vision and Dental?
Just like routine dental care, routine vision care is also not covered by Medicare. Routine eye exams and services are excluded from coverage.
The good news is that Medicare beneficiaries are not left to fend for themselves with no dental options. There are stand-alone plans that beneficiaries can enroll in. They can include either dental, vision, or hearing benefits. Or, you can purchase a stand-alone plan that bundles all three together.
The other option is a Medicare Advantage plan. These plans can include extra benefits like routine dental, vision, and hearing benefits.
Some Medicare Advantage plans include extra benefits for dental and vision. Some even include benefits for prescription drugs. The dental and vision benefits with these plans do include coverage for routine care as well as more complex procedures.
When you have a Medicare Advantage plan, your medical costs are being paid for by the Advantage carrier instead of Medicare. Medicare Advantage plans must cover all the same services that Part A and Part B of Original Medicare covers. The caveat is your coverage is no longer standardized by the government. Your summary of benefits will vary from carrier to carrier.
Many Medicare beneficiaries choose to enroll in a Medicare Advantage plan for these extra benefits. You still have to enroll in Part A & Part B and pay the premiums to be eligible. In some areas, some Medicare Advantage carriers offer a give-back benefit. This benefit reduces your monthly Part B premium. It’s important you check that all your doctors are within the plan’s network prior to enrolling.
You can also explore the Medicare Advantage plans available in your area by using the Plan Compare Tool on Medicare.gov. All you have to do is select the Medicare Advantage Plan option and enter your ZIP code.
You can then choose to see your drug costs if you’re interested in prescription drug coverage with your Medicare Advantage plan. If you select yes, be prepared to enter the name, dosage, quantity, and frequency of each medication that’s prescribed to you.
Once complete, you will be given a list of available plans in your area. You can see the monthly premiums, estimate the yearly cost of your medications, the maximum out-of-pocket limits, the deductibles, and more. Once you decide on a plan, you can self-enroll.
FYI: Both Medicare Advantage and Medigap have their own benefits when it comes to dental care. To learn more, read my guide: Medicare Advantage vs Medigap.
Even though Original Medicare doesn’t cover routine dental care, beneficiaries still have options to supplement their benefits. Stand-alone dental plans can run anywhere between $10-$30 per month. Affordable dental insurance for seniors might cost even less. Medicare Advantage plans can cost around the same, and sometimes even have a zero-dollar premium.
If you’re confused about what you’re signing up for, it’s always best to contact a licensed agent. They can compare all your options side by side and explain exactly what you’re getting so that you have peace of mind in your coverage selection.
If you receive dental-related treatment or undergo a dental-related surgery at the hospital, Part A will cover it. If you receive any dental treatment or surgeries related to another covered service at the doctor’s office, Part B will cover it.
You can supplement your Medicare benefits with either a stand-alone dental plan or a Medicare Advantage plan that includes dental benefits.
Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017 and is featured in many publications as well as writes regularly for other expert columns regarding Medicare.