Original Medicare (Parts A and B) does not cover routine dental services, like cleanings, fillings, or dentures, meaning seniors enrolled in Original Medicare may need to seek supplemental dental coverage. The three primary options for seniors on Original Medicare to get dental insurance are enrolling in a Medicare Advantage Plan (Part C) that includes routine dental benefits, purchasing a stand-alone dental insurance policy, or utilizing a dental discount plan. It is crucial to evaluate your current and future oral health needs, along with out-of-pocket costs, to choose the right comprehensive plan.
Does Original Medicare (Parts A and B) cover routine dental care?
No, Original Medicare doesn’t cover most dental services. Cleanings, fillings, tooth extractions, dentures, dental plates, and other dental devices are 100% the responsibility of the patient under Original Medicare. However, seniors should still prioritize preventive dental care, as maintaining good oral health can help reduce risk for heart disease, strokes, dementia, and other age-related health conditions.1
What dental services does Original Medicare specifically exclude?
Routine cleanings and exams
Fillings, crowns, and bridges
Root canals
Tooth extractions (unless medically necessary)
Dentures and implants
Routine, preventive dental X-rays
Are there any exceptions for dental coverage under Medicare Part A?
Medicare Part A, also known as hospital insurance, generally does not cover routine dental care. The exception is for dental services you receive if you’re admitted to the hospital for your dental procedure, or for specific inpatient or outpatient dental services related to certain covered medical treatments. This may include dental or oral exams and treatments—such as necessary extractions—performed before or during major medical events, such as organ transplants, heart valve replacement surgery, or treatment for head and neck cancers.
Three Ways to Get Dental Coverage as an Original Medicare Beneficiary
If you have a history of dental issues or want to better control your dental expenses, you may choose to have some form of dental coverage while enrolled in a Medicare plan. Explore your options below.
Option 1: Choosing a Medicare Advantage Plan (Part C) with Routine Dental Benefits
Medicare Advantage Plans (Medicare Part C) provide an alternative to Original Medicare, but may include additional benefits, such as routine dental coverage. Part C plans that include routine dental benefits typically cover preventive and comprehensive services, although coverage varies by plan.
Option 2: Purchasing a Standalone Dental Insurance Policy for Seniors
Offered by private health insurance providers, standalone Medicare dental insurance plans come with a monthly premium and usually require you to see an in-network dentist. The coverage you receive from a standalone plan may help offset the cost of out-of-pocket services. Most standalone dental plans have tiered coverage, which means that basic services are covered at 100%, basic procedures are covered at 80%, and complex procedures are covered at 50%.
Option 3: Utilizing a Dental Discount Plan with Medicare
With Medicare dental discount plans, you’ll typically pay an annual or monthly membership fee entitling you to receive a discounted rate for any services received from an approved list of dentists.
Factors to Consider When Choosing Your Medicare Dental Insurance
Your Current and Future Dental Health Status
Choosing the right dental coverage as an Original Medicare beneficiary requires careful consideration of your current and anticipated oral health needs. The first step is to assess your history and future expectations for dental care: are you seeking coverage for routine preventative care, such as two annual cleanings and check-ups, or do you have a history of issues that may require more intensive procedures? If you anticipate needing services like fillings, simple extractions, or periodontal treatment, you'll need at least basic coverage, while complex work such as crowns, bridges, root canals, or dentures may necessitate a plan that offers major restorative benefits.
Analyzing Out-of-Pocket Costs and Annual Maximum Limits
As you evaluate your options for standalone Medicare dental plans, it’s important to understand the limits on what the insurer pays. Annual maximum limits are the absolute cap on what the insurance company will pay for your dental services in a plan year, after which you must pay all remaining costs out-of-pocket, especially for high-cost procedures like crowns or implants. Separately, your personal out-of-pocket costs—which include deductibles, copayments, and coinsurance—determine how much you pay for each service before you reach that annual maximum. Therefore, if you expect extensive dental work, a plan with a higher annual maximum and lower coinsurance percentage, despite a potentially higher premium, may save you more money in the long run.
Let SelectQuote Help
Interested in learning more about your dental coverage options as an Original Medicare beneficiary? Connect with SelectQuote. If you’re new to Medicare, have recently moved, or lost your health insurance, you may be eligible for a free, no-obligation Medicare Advantage plan review with a licensed insurance agent.
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