Does Medicare Cover Dental for Seniors?

Original Medicare (Parts A and B) typically does not cover routine dental services. The only exceptions are when dental services are a necessary part of another procedure covered, and/or a hospital stay is required. Medicare Advantage, on the other hand, often bundles dental insurance for seniors.

If you have Original Medicare (Parts A and B), your dental care is covered only in specific cases. Medicare may pay for:

• Dental services that are necessary to perform another covered procedure
• Tooth extractions before radiation treatments for neoplastic disease
• Oral exams before kidney or heart valve replacement
• A hospital stay if your dental procedure requires it

This limited Medicare dental coverage doesn’t include cleanings, x-rays or other routine dental services.

Does Medicare cover dental?

No. Despite several recent expansions to Medicare policies, adding Medicare dental insurance for seniors wasn’t one. As of this year, Medicare dental coverage is minimal.

Why is dental care not covered by Medicare?

Dental has always been excluded from the Medicare system. It is not considered one of the 10 Essential Health Benefits under the Affordable Care Act (ACA). The only change came in 1980 when Congress amended it to include an exception for inpatient hospital services. Since then, Part A may help cover your hospital stay if your procedure includes an inpatient stay.

While you may have heard the term “Medicare Dental coverage,” it’s not one of the federally funded parts of Medicare. That said, if you are over 65, there are plenty of ways to get dental insurance for seniors. Here are your options:

Stand-alone dental plans for seniors

If you have Medicare, private insurance companies provide dental plans. Like health insurance, you can shop for different plans and pick the coverage options you need. If you have Original Medicare (Parts A and B), or a Medicare Advantage plan that doesn’t include dental coverage, you can add a policy separately. Keep in mind that means you’ll also be responsible for that plan’s copays, coinsurance and deductible.

Medicare Advantage plans that include dental insurance for seniors

Medicare Advantage (Part C) is an alternative to Original Medicare. It replaces Original Medicare (Part A & B), but offers the same Part A & B benefits or coverages as Original Medicare.

Where does dental coverage come in? Along with receiving Part A & B benefits, Medicare Part C often bundles additional services like hearing, vision, prescription drug coverage and, yes, dental coverage.

Now you can answer the question: Does Medicare cover dental? The next step is to figure out how to find dental insurance for seniors and enroll.

If you have Original Medicare or Medicare Advantage without dental coverage: You can add a separate dental policy whenever you need it.

If you want to enroll in a Medicare Advantage plan with dental coverage:
Whether or not you already have Medicare, dental can be added at various times. These are known as enrollment periods. Here are the dates to know:

• Enroll during your Initial Enrollment Period (IEP): This is a seven-month window around the month you turn 65. The IEP is your first chance to enroll in Medicare.
• Medicare Part C & D Open Enrollment Period: Original Medicare enrollees can switch to a Medicare Advantage plan with dental insurance for seniors. Held annually from October 15 to December 7.
• Medicare Advantage Open Enrollment Period: Have a Medicare Advantage plan without dental? You can switch to one with dental coverage each year from January 1 to March 31.

Have you ever asked: “Is there a dentist near me that accepts Medicare?” If so, wonder no more: There are several ways to find a dentist that accepts your coverage. Remember, if you only have Original Medicare (Parts A and B), your dental care probably isn’t covered.

• If you have stand-alone dental coverage, call your prospective dental office and ask if they accept your insurance.
• If you have Medicare Advantage, call your licensed insurance agent and ask them to check that you have Medicare dental coverage included in your plan and whether your dentist accepts it.
• If you’re signing up for Medicare Advantage, let your agent know that you need dental coverage. If you don’t have an agent of record, give GoHealth a call. We’ll show you which Medicare Advantage plans include dental services, which practices are covered, and how much it all costs.

The answer here is based entirely on you. Start by considering your needs and budget. Some dental plans for seniors cover a lot but come with high monthly premiums; others are cheaper but don’t provide the same coverage for dental services.

When trying to find a dental plan that works for you, here are some things to consider:

• Check out your plan’s provider network. This is the group of dentists and other providers that have agreed to accept your dental insurance.
• Does your spouse have a dental plan through their employer? If so, you may be able to join their plan.
• Are there dental discount plans available? While these aren’t insurance, their paid memberships come with dental services at discounted rates.