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Dental Coverage Under Medicare

Original Medicare (Part A for hospital coverage and Part B for medical coverage) typically does not include routine dental coverage, such as dental exams, cleanings, fillings, crowns, and bridges. There are, however, some exceptions to this rule.

When Medicare was first launched, it didn't include routine dental coverage. This changed in 1980, when an amendment to Original Medicare was created to allow Medicare coverage of inpatient hospital services for dental procedures that make hospitalization necessary. Presently, Medicare may provide all or part of your dental coverage when it involves other services covered under Medicare Part A or Medicare Part B.

For example, it you suffer an accident that results in damage to the jaw, Medicare would cover the medical reconstruction of the jaw. Or if you have a disease involving the jaw, Medicare might cover a tooth extraction that is directly caused by the disease.

For emergency and complicated dental procedures that require a hospital stay, Medicare Part A covers the hospital stay but not the dental procedure.

If you're having a kidney or heart transplant or another complicated procedure that requires a preliminary dental exam, Medicare covers the dental exam either under Medicare Part A or Medicare Part B, depending on whether the dental exam is performed by hospital staff or an in-office physician.

Getting dental coverage under Medicare

Since routine dental coverage is not available under Original Medicare, you are generally responsible for the full cost of your dental care unless you have other dental insurance. Here are a few options to receive dental coverage when you're a Medicare beneficiary.

Dental insurance

For complete dental coverage, you can shop online at www.ehealthinsurance.com to learn about and buy an individual dental insurance plan that fits your personal needs.

You may also have group dental insurance available, if either you or your spouse is employed. Be sure to read the plans carefully. Some dental plans require you to stay within a network of dental care providers. The premiums may be a bit higher for this type of plan, but the costs are offset by lower out-of-pocket fees, like copayments, coinsurance, and deductibles, mainly because network dentists usually agree to charge discounted rates to members of the dental plan. Other plans let you go to any licensed dental professional, but you may have to pay more at the time of service.

Dental coverage through Medicare Advantage

You may be able to get dental coverage under some Medicare Advantage plans. Medicare Advantage (Medicare Part C) can include extras like routine dental, routine vision, and Medicare prescription drug coverage. You can check out Medicare Advantage plans in your area by visiting www.planprescriber.com.

Dental discount cards

Some dental care provider organizations offer dental discount cards. This is neither Medicare nor dental coverage, and there are no dental benefits payable to you or the dentist.

You basically have to pay the total cost of your dental care, but with a dental discount card, you get access to a network of dental professionals who agree to discounted rates for dental exams, cleanings, fillings, and more. You pay one annual fee to be in the program and then use the card whenever you receive dental care. Ask your dental care provider if he or she offers these discount cards.

Medicare has neither reviewed nor endorsed this information.

eHealth Medicare is operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.