Original Medicare does not cover most routine dental care, but there are other ways to get coverage.
While Medicare does cover a wide range of services, it does not cover dental care. This includes cleanings, fillings and extractions. You may be eligible to receive certain services under Medicare Part A, your hospital insurance.
What does Original Medicare mean for dental care?
The short answer is that Original Medicare (parts A and B) doesn’t cover most dental care, including cleanings and fillings. According to the Kaiser Family Foundation, almost two-thirds (33%) of Medicare beneficiaries do not have dental coverage. Some dental services can be covered by Medicare Part A (your hospital insurance).
Medicare, for example, would cover the cost of a jaw reconstruction after an accident injury or tooth extractions required prior to radiation treatment. An oral exam would be covered before any procedure such as a kidney transplant, heart valve replacement or kidney transplant. However, you won’t be covered for any treatment that results from the exam. If the exam was performed by a hospital dentist, Medicare Part A would cover it. Medicare Part B would cover you if you were examined by a doctor.
Part A would cover your hospital costs if you need emergency or complex treatment. However, the actual dental care would not be covered. Similarly, Medicare Supplement Insurance (Medigap) plans will not cover routine dental care.
What about Medicare Advantage?
Medicare Advantage plans, sometimes referred to as Medicare Part C, may provide additional coverage that isn’t available with Original Medicare Part A or Part B. This includes dental care. This could include routine X-rays, extractions, and teeth cleaning.
Medicare Advantage plans are offered by private insurance companies that have been approved by Medicare.
There are many types of Medicare Advantage plans. They offer different coverages and cost structures. Make sure that the Medicare Advantage plan you are considering provides dental coverage for a specific type of tooth.
Other options for dental insurance
To get dental coverage, you don’t need to be a member of Medicare. Separate dental insurance coverage can be purchased. A number of major insurers, including Humana, United Healthcare and Aetna, offer dental coverage. AARP also offers Delta Dental plans for members.
These plans are similar to other insurance policies you have used: You pay a monthly fee and have access a variety of in-network dental care providers. You may be eligible to travel out of your network for a higher cost depending on which plan you have. However, you may not be covered for out-of-network dentists.
You can also choose from the following coverage options:
- A discount dental plan: This is similar to joining a discount club like Costco. To be able to access a group dentists offering a discount rate, you must pay a fee.
- You may be eligible to enroll if your partner or spouse has dental coverage.
- Employer’s dental coverage: If your employer offers dental benefits, it is possible to enroll and receive group rates.
Typical senior dental costs
According to the Kaiser Family Foundation, nearly one in five Medicare beneficiaries who visited a dentist within the last year spent more than $1,000 in dental care in 2016. The following are some examples of dental costs:
- Basic cleaning: $70 – $200
- X-rays from $20 to $250
- Dental exam: $50-150
- Filling amalgams: $50-150
- Composite resin fillings: $90 to $255.
- Root canal cost: $300-$2,000
- Crown: $500 to $3,000
- Nonsurgical tooth extraction: $75-300
- Tooth extraction (surgical), $150-$650
According to a University of Michigan survey, 69% of those aged 50-64 who delayed seeing a dentist said that cost was their primary concern. Dental insurance can help keep out-of-pocket costs down and make expenses more predictable.
When and how to enroll
The type of coverage you select will determine how and when you enroll.
Medicare Advantage plan: You have three options to enroll in a Medicare Advantage Plan that includes dental coverage.
- Your Initial Enrollment Period is usually during the seven-month period between the three months prior to the month that you turn 65 and the three following.
- During open enrollment periods that happen each year, such as Oct. 15 to Dec. 7.
- If you are eligible due to circumstances such as moving, becoming eligible for Medicaid, or receiving care in skilled nursing facilities, you can enroll during a special enrollment period.
Separate dental insurance: At any time, you can sign up for a separate dental insurance plan.
Employer-provided dental insurance: If you or your spouse are still working, and it is possible to get coverage that way. However, you will need to wait until the open enrollment period (typically in fall) in order to enroll in group dental coverage.
You should be prepared for any unexpected circumstances. You might want to consider denture coverage if your dentist has suggested dentures or your teeth are in bad shape.
According to the 2019 survey by America’s Health Insurance Plans, 83% of dental customers are satisfied with their coverage. It saves them hundreds of bucks in out-of pocket costs. 65% also feel it reduces the worry about unexpected expenses. It’s a great investment.