Does Medicare cover dental?

More than 60 million Americans receive health insurance coverage through Medicare¹. But does Medicare cover dental care? While Medicare pays for a wide variety of health care expenses, typically it does not cover most dental procedures, dental care, or supplies. This means that if you’re currently on Medicare, it might be a good idea to purchase dental insurance to help you maintain good oral health while saving on out-of-pocket costs.

Parts of Medicare

Medicare has four different plans, or parts. The four types of Medicare programs are usually referred to as Part A, Part B, Part C, and Part D. Each part of Medicare covers something different and has different restrictions and benefits. Here’s a quick explanation of what each of these parts are and what they typically cover. For more information on Medicare, please visit medicare.gov.

Does Medicare Part A cover dental?

There is no coverage for most dental care under Medicare Part A unless dental care is part of an emergency, like if you’re in a car accident. Medicare Part A will pay for certain dental services that you may require while you’re in a hospital. It can also pay for inpatient hospital care if you need to have emergency dental procedures, though the dental services themselves won’t be covered⁵.  

Does Medicare Part B cover dental?

Medicare Part B does not cover any dental services. Dental insurance for seniors on Medicare is recommended in order to make sure that seniors get the routine care that they need like cleanings, exams, and fillings. Dental insurance can also help cover the cost of dentures, which Medicare typically doesn’t cover.

Medicare Part C

For seniors on Medicare, most dental care is not covered through Medicare Part A or Part B. However, you may be able to get dental coverage through a Medicare Advantage, Part C, plan². Also referred to as Medicare Advantage, Medicare Part C is a separate Medicare health plan you can purchase as part of Medicare. Medicare Part C is private health insurance, with various plans offered by private companies approved by Medicare.⁷

Medicare Part C is available for purchase in addition to Part A and Part B coverage, and usually offers additional benefits. You may be required to continue paying your Part B premium along with Medicare Part C costs. Additional coverage amounts, out-of-pocket costs, and rules vary from plan to plan. Traditional Medicare typically do not cover vision and dental, but with some Part C plans may offer vision and dental coverage⁸. The best Medicare dental insurance for seniors may be a Part C plan or it may be private dental insurance that will supplement their existing coverage.

Dental insurance is preventive care, you typically pay a small amount to get routine care like x-rays and cleanings. This allows you to maintain good oral health without paying a ton. Medicare, on the other hand, is set up as a health insurance plan, and like most health insurance plans, it is meant to be for major medical conditions rather than preventative care. Often Medicare plans have higher deductibles that you will have to meet before your insurance will kick in. Please visit medicare.gov for more information.

Dental insurance and medical insurance operate differently. Depending on your policy, dental care is often designed to be preventive, you typically pay a small amount for going in for routine visits and to receive care like X-rays, cleanings, and check-ups. Health insurance is typically designed to cover major medical and surgical costs. This difference may seem small but when you bundle dental and medical insurance, you may run the risk of paying more for your dental insurance than you would normally, even if the monthly premium is lower when bundled.

Another important consideration is that insurance companies that specialize in dental coverage often offer reduced rates that they have contracted for with network dentists. They also may have structures that allow them to process claims quicker.

Individual dental insurance may also offer more flexible plans in terms of deductibles and premiums. These plans also typically allow each individual to determine which services are most important to them and which are not.

No matter which plan you are purchasing, it makes sense to do research into your options before making a final decision. You should compare the monthly premiums, deductibles, and total out-of-pocket expenses before selecting a plan. The plan you choose should be flexible and fit your dental needs.

What does Medicare Part C cover?

Depending on the plan, Medicare Part C may include coverage for the following⁹:

• Vision care

• Hearing care

• Dental services

• Prescription drug coverage

Does Medicare Part A cover dental?

There is no coverage for most dental care under Medicare Part A unless dental care is part of an emergency, like if you’re in a car accident. Medicare Part A will pay for certain dental services that you may require while you’re in a hospital. It can also pay for inpatient hospital care if you need to have emergency dental procedures, though the dental services themselves won’t be covered⁵. 

Medicare Part B

Medicare Part B is medical insurance. These benefits cover certain medical expenses outside of hospitals. Parts A and B together are usually referred to as traditional Medicare. The biggest difference between Medicare Part A and Part B is that you’ll likely pay a monthly premium for Medicare Part B. The fee can be higher for people with higher incomes. For low-income beneficiaries, Medicaid can help cover Medicare Part B premiums. Medicare Part B usually doesn’t cover the full amount of a beneficiary’s health care costs.

What does Medicare Part B cover?

Medicare Part B typically covers the following types of services⁶:

• Medically necessary services, including procedures or supplies needed to diagnose or treat your medical condition.

• Preventive services, including health care to prevent illness or detect it early on. You’ll often pay nothing out of pocket for these services.

Does Medicare Part B cover dental?

Medicare Part B does not cover any dental services. Dental insurance for seniors on Medicare is recommended in order to make sure that seniors get the routine care that they need like cleanings, exams, and fillings. Dental insurance can also help cover the cost of dentures, which Medicare typically doesn’t cover. 

Medicare Part C

Also referred to as Medicare Advantage, Medicare Part C is a separate Medicare health plan you can purchase as part of Medicare. Medicare Part C is private health insurance, with various plans offered by private companies approved by Medicare.⁷

Medicare Part C is available for purchase in addition to Part A and Part B coverage, and usually offers additional benefits. You may be required to continue paying your Part B premium along with Medicare Part C costs. Additional coverage amounts, out-of-pocket costs, and rules vary from plan to plan.

Traditional Medicare typically do not cover vision and dental, but with some Part C plans may offer vision and dental coverage⁸.

What does Medicare Part C cover?

Depending on the plan, Medicare Part C may include coverage for the following⁹:

• Vision care

• Hearing care

• Dental services

• Prescription drug coverage

Does Medicare Part C cover dental?

Depending on the plan, some Medicare Advantage Plans may cover dental services, such as cleanings, X-rays, tooth extractions, fillings, and dentures. However, specifics of these extra benefits vary from plan to plan. Contact your plan provider for additional information.

Medicare Part D

Medicare Part D offers optional prescription drug coverage to everyone on Medicare. It’s available for purchase as a standalone plan through private insurers, with fees varying from provider to provider¹⁰. Though coverage amounts, deductibles, and copay costs vary across the board, each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage.

What does Medicare Part D cover?

Medicare Part D plans typically cover part of the costs of at least two drugs in the most commonly prescribed categories. Specific drugs covered by certain plans will vary greatly, since plans can choose which drugs covered by Part D they will offer. For more information on Medicare, please visit medicare.gov.

Does Medicare Part D cover dental?

Medicare Part D does not cover any dental services. 

Medicare dental plans

Though traditional Medicare does not provide coverage for dental insurance, Medicare Advantage Plans (also known as Medicare Part C) typically do. In fact, as of 2020, 88% of Medicare Advantage Plans provide some amount of dental benefits¹¹.

This doesn’t mean all 88% of those plans provide comprehensive dental benefits. Medicare wasn’t designed to include routine dental care. Medicare’s dental coverage is meant to be limited to situations integral to other medical treatment. So, many Medicare Advantage plans typically have high out-of-pocket costs and low annual benefit maximums.

Medicare Advantage Plans are only available during specific enrollment periods. Open enrollment for Medicare Advantage Plans is typically available in the Fall. If you missed the open enrollment period to purchase a Medicare plan that includes dental insurance, don’t worry. You can still purchase dental insurance any time of the year, even while on Medicare. Just make sure to note when the next open enrollment period is if you want to get on Medicare Advantage Plan during the next open enrollment.

How to find the best dental insurance for seniors on Medicare ?

Nearly two-thirds of Medicare enrollees have no dental insurance¹². Chances are, if you’re unemployed, or retired and on Medicare, you’re likely no longer receiving dental insurance benefits from a full-time employer. But that doesn’t mean you can’t get dental insurance coverage. Purchasing direct dental insurance is an option for seniors who may have lost dental benefits once they retired. Plus, it’s available for purchase all year round online, so you don’t have to wait for a designated enrollment period. You could get approved for a plan within minutes.

People over 65 are at an increased for oral health problems, such as gum disease 12, and without dental insurance, you might find yourself putting off treatment. Advancing age can bring all kinds of dental and periodontal (gum) issues, many of which need proper treatment to prevent further health issues that result from them. Having a comprehensive dental insurance plan is an important part of helping maintain oral health.
There are a few dental issues that typically impact seniors more than other people, these include:

• Periodontitis (gum disease) - Gum disease impacts about 20% of seniors 65 and over.13 It is often perceived as a small issue and many seniors may ignore the symptoms associated with gum disease. This is a mistake. Periodontitis can cause teeth to loosen and fall out and, without treatment, can cause the underlying bone to be destroyed.14 The good news is that periodontitis is typically preventable with routine dental visits and good oral hygiene.
  
  

• Tooth decay - As of 2018, over 90% of seniors over 65 have had a cavity permanent tooth and about 20% have untreated tooth decay⁶. Untreated decay can lead to other, more expensive, and painful issues like root canals and abscesses. However, teeth can be treated when you see the dentist regularly. Having dental insurance allows you to see your dentist for regular cleanings, allowing you to have small amounts of decay removed before it gets out of hand.
  
  

• Oral Cancer⁷ - Oral cancer is a particularly dangerous form of cancer that is estimated to be responsible for over 10,000 deaths in 2020. The median age for diagnosing oral cancer is 63 years old. Like many oral health issues, cancer can typically be caught early with routine dental visits and it is one of the things that your dentist is looking for when you go in for your regular cleanings.

Affordable dental insurance for seniors

There are two main insurance plan options that you’ll be able to choose from when you’re looking for affordable dental insurance for seniors as a retired senior citizen: PPO (Preferred Provider Organization) plans, and Dental Health Maintenance Organization (DHMO) plans.

PPO plans typically give you access to a wide range of dentists, and in some cases, you may be able to continue seeing providers outside the network. PPO members pay a monthly premium, and the plan covers a percentage of your costs after you’ve met your deductible. If you need individual health insurance and already have a dentist that you know and trust, PPO plans can be a good option.

DMHO plans require you to choose a single dentist or dental office as your in-network provider. If you need to see a specialist, like a periodontist or an oral surgeon, your primary dentist will give you a referral authorized by your insurance company. When you have a DMHO plan, you likely won’t have a deductible or an annual cost. Instead, you typically pay a copayment for any dental services you receive covered under the plan. This is typically an affordable type of dental plan, and many basic dental services typically don’t have a copay.

Dental insurance covers a portion of the cost of many common dental services, from preventive care to emergency dental surgery.

While coverage amounts vary from plan to plan, most dental insurance plans help cover a portion of the cost of the following dental services:

• Oral exams

• Cleanings

• X-rays

• Fillings

• Extractions

• Oral surgery

• Root canals

• Crowns

• Implants

• Orthodontics

On the other hand, traditional Medicare typically covers the following:

• Dental services that you may require while you’re in a hospital (such as jaw reconstruction after an accident, for example).

• Inpatient hospital care for emergency dental procedures (though dental services themselves are not covered.

Other dental services may be partially covered if you have a Medicare Advantage Plan also known as Medicare Part C. Check your plan to determine your coverage. For more information on Medicare, please visit medicare.gov.

The cost of dental plans for seniors

The cost of dental plans for seniors depends on a few factors such as age and where they reside. As with other types of insurance, typically plans with higher monthly premiums often have lower deductibles and copays whereas plans typically with lower monthly premiums have higher deductibles and copays.

Many plans may also have a waiting period before procedures like cavities or root canals can be done. It is a good idea to enroll for dental insurance as soon as possible so that these conditions do not develop, and you do not have to wait to receive treatment.

Dental and vision insurance quote for seniors & Insights

Regardless of your dental coverage needs, it is important that you have all of the information that you need related to insurance before you decide on the right plan for you. Guardian Direct® has a wealth of resources available to you so that you can make a smart choice that gives you the best coverage that you can afford. Guardian Direct is committed to helping seniors find great dental insurance that will help them maintain their health as they age and has created a vast library of articles designed to help seniors choose the right dental insurance and learn more about the value of preventative dental care at home.


Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice and is not intended to influence any reader’s decision to select, enroll in or disenroll from a Medicare plan. Although the information has been gathered from sources believed reliable, please note that individual situations can vary, therefore the information should be relied upon when coordinated with individual professional advice.

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