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Does Medicare cover dental?

Traditional Medicare typically doesn’t cover any dental services, but some types of Medicare provide limited coverage.

12 minute read

More than 60 million Americans receive health insurance coverage through Medicare1. But 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.

What is Medicare?

Medicare is a federal health insurance program for U.S. citizens who are 65 or older and people with qualifying disabilities or medical conditions. Different parts of Medicare help cover specific services, including hospital insurance, medical insurance, and prescription drug coverage. Dental care for seniors on Medicare depends on what type of Medicare plan that you’re enrolled in. 

Traditionally Medicare coverage for dental is restricted to emergency care2. Medicare is considered an entitlement program, similar to the Social Security benefits. Most U.S. citizens earn the right to enroll in Medicare by working and paying taxes for a minimum number of years, though some may still be eligible to enroll at a higher rate even if they don’t meet the minimum requirements.

Medicaid vs. Medicare

Though Medicare and Medicaid sound similar, they are two different programs. Both programs can help U.S. citizens pay for health and medical expenses, but they’re structured to benefit different groups. Medicaid provides health coverage based primarily on financial need, including eligible low-income adults, elderly adults, pregnant women, children, and people with disabilities. Medicaid does cover some level of dental care for children, though they do not require states to provide any dental benefits to adults. Medicare may offer some dental coverage in one of the four coverage plans that are offered but it’s not part of the standard care that Medicare pays for3

Medicare, on the other hand, is a federal health insurance program that guarantees coverage for individuals over age 65 and some younger people with disabilities. Does Medicare cover dental care? Dental care for seniors on Medicare may be a part of some of the Medicare plans, but not all of them. 

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.

Medicare Part A

Medicare Part A is hospital insurance.  Medicare Part A beneficiaries don’t have to pay a monthly premium to receive this type of coverage under Medicare. You’re eligible for premium-free Part A if you’re over 65, you’ve worked at least 10 years, and you paid Medicare taxes while you worked. Otherwise, you can still receive Part A if you pay a monthly premium. 

However, this doesn’t mean you’ll receive free medical care if you’re covered by Medicare Part A. This coverage usually doesn’t cover the full amount of a hospital bill, so you’ll likely have to pay a portion of costs out-of-pocket as well as meet a deductible before any benefits are paid. You don’t have to pay up front though, after you receive care the bill is sent to the government. Once the government decides what portion they will pay, you are likely to  be responsible for the rest. 

What does Medicare Part A cover?

Medicare Part A typically covers the following4:

  • Hospital inpatient care, 
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health care

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 can I get dental insurance while 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.

What does dental insurance cover that Medicare doesn’t?

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.

I’m retired – is dental insurance worth it?

Dental health has a direct impact on physical health. Studies have shown there is a link in seniors between gum disease and heart disease13. Overall, researchers have found that seniors with healthy teeth and gums are less likely to suffer from heart attacks and other serious health complications.

While people of all ages can benefit from dental insurance, dental insurance for adults over 65 can supplement your Medicare coverage and help you pay for preventive care, as well as major dental services, which is important since adults over 65 are more likely to have tooth decay, gum disease, tooth loss, and oral cancer.14

Almost two-thirds of people on Medicare don’t have any dental coverage , dental insurance can help reduce the cost of keeping your teeth healthy. If you’re currently on Medicare and you don’t have any dental insurance coverage yet, consider purchasing individual dental insurance.

 

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.\

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.
 

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Sources:

1. https://www.kff.org/medicare/state-indicator/medicare-beneficiaries-as-of-total-pop, 2018
2. https://www.medicare.gov/coverage/dental-services, accessed September 2020
3. https://www.medicare.gov/coverage/dental-services, accessed September 2020
4. https://www.medicare.gov/what-medicare-covers/what-part-a-covers, accessed September
5. https://www.medicare.gov/coverage/dental-services, accessed September
6. https://www.medicare.gov/what-medicare-covers/what-part-b-covers, accessed September 2020
7. https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work, accessed September 2020
8. https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work, accessed September 2020
9. https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work, accessed September 2020
10. https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage, accessed September 2020
11. http://files.kff.org/attachment/Data-Note-Medicare-Advantage-2020-Spotlight-First-Look, 2020
12. https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries, 2019
13. https://www.cardiosmart.org/news/2016/1/gum-disease-linked-to-increased-risk-for-heart-attack
14. https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm, 2019

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.
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