As an independent Medicare specialist, “does Medicare cover dental expenses” is in the top 10 of our Medicare frequently asked questions.

Medicare can be confusing when it comes to understanding what’s covered and what isn’t covered. If you’re focused on taking care of your oral health, you should first understand if dental expenses are covered by Medicare.

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The good news is Medicare beneficiaries have options when it comes to finding the best coverage that will meet their individual circumstances and budget.

We’re here to help you make the best decision for obtaining dental care coverage and explain when Medicare covers dental expenses.

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What Dental Procedures are Covered by Medicare?

The bad news is that Medicare doesn’t cover routine dental care such as cleanings, extractions, root canals, dentures, or implants.

Medicare Part A and Part B only cover dental services that are considered medically necessary for an underlying medical procedure.

For example, Medicare Part B will likely cover the cost of a dental exam before getting a heart valve replacement or kidney transplant. And Medicare Part A will cover the cost of tooth extractions that are needed for reconstructive jaw surgery resulting from an injury.

So, the bottom line when it comes to Medicare and dental procedures, is that Medicare will only cover dental expenses if the needed procedure is in combination with another medically necessary procedure.

What About Medicare Part D?

Since Medicare Part D is designed to cover your expenses for retail prescription drugs (drugs that are self-administered), Part D would only pay for drugs you’ve been prescribed by your doctor, specialist, or dentist.

For example, if you see your dentist to have a tooth extracted, Part D would not pay for the extraction but would pay for the antibiotics most dentists or oral surgeons prescribe following your extraction.

Moreover, if your extraction becomes infected, and that infection spreads and becomes severe, your Medicare Part B would cover the doctor’s care that results from the infection. If your infections land you in the hospital, Medicare Part A would cover the resulting hospital expenses.

Will a Medigap Plan Cover Dental Expenses?

Medicare Supplement (Medigap) plans will not cover your expenses for routine dental care. However, a Medigap plan will likely cover your coinsurance costs or deductible if you require emergency dental procedures that would fall under your Medicare Part A coverage.

Most seniors who are enrolled in Original Medicare and have purchased a Medicare Supplement plan will generally purchase a stand-alone dental plan or a low-cost discount dental plan.

Both of these types of dental plans will likely come with a yearly maximum payout, deductibles, coinsurance, a schedule of covered services, and a network of dentists that you must choose from. However, keep reading because there is another way to get dental expenses covered!

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Does Medicare Advantage Cover Dental Expenses?

Medicare Advantage (Medicare Part C) is an option available to all enrollees of Original Medicare. Unlike Medigap Plans that supplement Original Medicare Part A and Part B, a Medicare Advantage replaces Original Medicare and is administered by private insurance companies that have been approved by Medicare.

With a Medicare Advantage Plan, policyholders get the same coverage in Medicare Parts A and B, and additional coverages that Medicare Parts A and B do not offer:

  • Prescription Drug coverage
  • Dental coverage (emergency and routine)
  • Denture coverage
  • Vision coverage
  • Hearing coverage

Although all Medicare Advantage plans must offer the coverages found in Original Medicare Part A and Part B, each insurance company can offer any or all of the above-listed coverage plus additional benefits like gym memberships.

The dental coverages offered vary among each insurance company so it’s critical that you speak with an independent Medicare specialist to find the dental coverage that is the best fit for you.

Moreover, your Medicare Advantage plan will likely require you to choose a dentist who is in your plan’s network. Most plans will also have an annual limit on how much they’ll pay out for dental benefits and many plans place a limit on procedure coverage.

For example, you may have coverage for dentures limited to 50% and a limit of $1,500.

Additionally, you will still have to pay your Medicare Part B monthly premium and your Medicare Advantage premium (if any). However, depending on your zip code, many insurance companies offer zero-premium Medicare Advantage plans, and in some areas, the company will even refund a portion of your Part B premium.

So then, rather than having to pay significant out-of-pocket dental expenses, an additional premium for a stand-alone dental plan, you should consider switching from Original Medicare to a Medicare Advantage plan that will offer dental coverage as well as other coverages.

If you decide to shop for a Medicare Advantage plan (Medicare Part C), you can do it the hard way or the easy way.

The Hard Way

The hard way to shop for a Medicare Advantage plan that is right for you is to call every company that offers a plan in your area (typically 6 or more companies), speak with a representative, take notes, and then compare with all other companies.

However, when you speak with a company representative, remember that they work for the company and not for you.

The Easy Way

The easy way to shop for a Medicare Advantage plan is to speak with an independent insurance professional who specializes in Medicare like the Medicare Solutions Team.

The Medicare Solutions Team represents many of the highly-rated private insurance companies that offer Medicare Advantage plans. These specialists represent many companies but aren’t employed by any of them.

This means that your Medicare Solutions Team member will submit your case to all of their carriers simultaneously and then deliver a Medicare Advantage solution that is right for your needs and your budget.

Have Questions?

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