Does Medicare Cover Dental? What It Pays For and Where to Check

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). It generally does not cover the dental care most people need from year to year, including:

• Cleanings and routine exams
• Fillings
• Extractions
• Dentures

If you have Original Medicare and no other dental coverage, you would generally pay the dental office's fee for that care yourself. Typical US fee ranges, which vary widely by region and provider, are on the cost pages for a dental cleaning, a tooth extraction and dentures.

The word "generally" matters. There are exceptions, described next, and the details are set by Medicare, not by this site.

Original Medicare can cover certain dental services when they are tied to medical care that Medicare covers. In broad terms, the dental service is connected to the covered medical treatment, as opposed to being dental care for its own sake.

A few points to keep in mind:

• The list is specific and limited. It is defined by Medicare, and it has changed over time. Medicare's official site describes the current rules.
• It is decided under Medicare's rules. A dental problem being painful or urgent does not make its treatment a covered service.
• Your medical team and dentist are part of the process. If a doctor or hospital tells you that dental work is needed in connection with a medical treatment, ask them and the dental office whether they expect Medicare to cover it and how it would be billed.
• Ask before treatment where you can. Find out what you would owe if Medicare does not pay.

Because this area is narrow and has changed, do not rely on a general article, including this one, for whether your situation qualifies. Check with Medicare and with the providers involved.

Medicare Advantage plans are another way to receive Medicare coverage, through a private plan. Many of them include some dental benefits that Original Medicare does not.

"Some dental benefits" covers a wide range. Between plans, these things commonly differ:

• Which services are included. Some plans include only preventive care such as cleanings, exams and x-rays. Others also include fillings, extractions, crowns or dentures, usually with more of the cost left to you.
• The yearly dollar limit. Many plans cap what they pay for dental care each year, much as an annual maximum works in other dental coverage.
• Your share. You may pay a copay or coinsurance for each service.
• The network. Some plans pay only, or pay more, when you see a dentist in their network.
• How often. Plans commonly limit the number of cleanings, x-rays or replacement dentures in a period.
• Approval rules. Some services may need the plan's approval before treatment.

Benefits, networks and costs can change from one year to the next, so last year's summary may not describe this year's plan. This site does not name or rank plans. Dental is also only one part of a Medicare Advantage plan, and the choice between Original Medicare and Medicare Advantage affects all of your health care.

Searches for "Medicare dental plans" and "Medicare dental coverage" usually point to one of two things.

A Medicare Advantage plan that includes dental benefits. The dental benefit comes as part of the plan, as described above.

A separate private dental plan bought alongside Medicare. This is ordinary individual dental insurance. It is not part of Medicare, even when it is marketed to people of Medicare age.

Individual dental plans commonly work like this, though every plan varies:

• A monthly premium, commonly quoted at roughly $20 to $60 for one person
• A deductible, commonly $50 to $100
• Preventive care often paid at 100 percent, basic care such as fillings at 80 percent, and major care such as crowns at 50 percent
• An annual maximum, commonly $1,000 to $2,000 per person
• A waiting period before some care is covered: often none for preventive care, around 6 months for basic care, and 6 to 12 months for major care

Whether a separate plan pays for itself depends on the care you expect in the coming year. The dental insurance worth-it tool sets a year of premiums against the care you enter, using your own numbers. It is an estimate for planning, not advice on what to buy. The article on dental insurance for seniors goes into more detail.

A dental discount plan is a third option that is not insurance at all. You pay an annual fee, commonly around $100 to $200, for reduced fees at participating dentists, with no annual maximum and no waiting period.

Depending on your circumstances, other programs may cover some dental care.

• Medicaid. Adult dental benefits under Medicaid are optional for states and vary from emergency-only care to extensive coverage. If you have both Medicare and Medicaid, ask your state Medicaid program what dental benefits apply. The article on whether Medicaid covers dental explains how much this differs by state.
• The VA. Dental care through the VA is limited to veterans who meet specific eligibility classes, for example a service-connected dental condition or a 100 percent disability rating. Other enrolled veterans can buy private coverage through the VA Dental Insurance Program. See dental care for veterans.
• Retiree or employer coverage. Some people keep dental coverage through a former employer or a spouse's plan. The plan administrator can tell you what applies once you are on Medicare.

Having no dental benefit does not mean having no options. Lower-cost care exists in most states:

• Dental school clinics, which often charge reduced fees
• Community health centers, many of which offer dental care with sliding-scale fees
• Charity clinics and events, which provide free or low-cost care

Private dental offices can also help. Ask for the cash fee, ask whether a payment plan is available, and ask for a written estimate that lists each procedure. The articles on seeing a dentist without insurance and free dental care go further.

A few steps settle most questions:

• Find out which kind of Medicare you have. Original Medicare and Medicare Advantage are treated very differently for dental care. If you are not sure, your plan paperwork or Medicare can tell you.
• Read the dental section of your plan documents. Look for the covered dental services, the yearly limit, your share of each service, network rules and anything that needs approval first.
• Call the plan. Ask whether the specific service you need is covered, what you would pay, and whether your dentist is in the network.
• Ask the dental office to check your benefits. Many offices will verify coverage before treatment and give you a written estimate of your share.
• Use Medicare's official site for the current rules on what Original Medicare covers, including dental services tied to covered medical care.

Before treatment, ask the dental office for the total fee and what you would owe if the plan pays nothing. An estimate is not a promise of payment, since plans decide what they pay when the claim arrives. The visit notes tool can keep your questions in one place.

Dental problems often become more involved the longer they are left. Pain, swelling, fever, a broken tooth or bleeding means being seen by a dentist now. Tell the dental office up front that you have Medicare and are worried about cost. Ask what the visit would cost without coverage and whether a payment plan is possible.

Trouble breathing or swallowing, swelling spreading toward the eye or neck, fever with facial swelling, or bleeding that will not stop means calling 911 or going to the emergency room. An emergency room deals with the emergency, and the tooth usually still needs a dentist afterward. If you are not sure how urgent your situation is, the ER or dentist tool goes through the warning signs.