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There are some shortcomings in Original Medicare (Part A and Part B) coverage, including most care for your teeth. Original Medicare doesn’t cover most routine dental care such as cleanings, fillings, tooth extractions, or dentures. In fact, Original Medicare generally only pays for emergency or complicated dental procedures. This means that you’ll generally only have dental care paid for when you’re in the hospital. If you have oral cancer or a jaw crushed in an accident for example, Original Medicare may pay for your care.
If you have a Medicare Advantage plan, it may cover dental services more extensively than Original Medicare (Part A and Part B) does. Medicare Advantage dental coverage is generally the only way to get dental services covered under Medicare.
It’s important to keep in mind that Medicare Advantage plans are offered by private insurance companies contracted with Medicare. These private insurance companies must cover everything that Original Medicare covers, and are able to offer additional coverage as well. Routine dental services would be considered additional coverage. Medicare Advantage dental services may vary from plan to plan. As you browse through Medicare Advantage plan descriptions, look under the “dental services” section. If it says “Medicare-covered benefits” you may not get any coverage beyond what Original Medicare covers, which does not include routine care.
All Medicare Advantage plans cover Medicare-covered dental services. You will generally pay a copayment for this, such as $45.
Some Medicare Advantage plans cover dental benefits beyond what Original Medicare covers. Medicare Advantage covered services could include:
The Medicare Advantage plan may limit your coverage to, for example, one cleaning every six months, one covered extraction a year, or one set of x-rays a year.
You generally will pay a copayment or coinsurance for most Medicare Advantage dental coverage, such as 50% coinsurance or a $50 copayment. If you have a Medicare Advantage plan that only covers “Medicare covered” benefits you may have to pay for routine services, such as cleanings and fillings 100% out of pocket. Medicare Advantage plans with more comprehensive dental coverage may have higher monthly premiums.
You also may have to use a provider within the plan’s network in order to be covered. There also may be an annual limit on Medicare Advantage dental coverage, for example, $1,000.
In addition to routine dental care, a Medicare Advantage plan may cover other services that Original Medicare generally doesn’t cover such as:
Still have questions about comparing Medicare Advantage plans? You can call eHealth to speak with a licensed insurance agent. If you’d like to explore the various Medicare coverage options in your area, use the Browse Plans button on this page.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.