Dental care can be costly. That’s why dental coverage is a key benefit to consider when choosing a Medicare or Medicare Advantage plan.

Original Medicare does not include routine dental coverage (such as dental procedures, cleanings or dentures), with the exception of certain dental services if you are hospitalized. However, you may be able to obtain routine dental care coverage through a Medicare Advantage plan. 

Do Medicare Advantage Plans Cover Dental?

Per the Kaiser Family Foundation, 90% of Medicare Advantage plans offer some type of dental coverage, and 94% of Medicare beneficiaries are eligible for Medicare Advantage plans that have dental coverage.

Ultimately, coverage depends on both your location and the Medicare Advantage plan selected. When considering your coverage options, check what types of dental benefits come with each plan and which best suits your dental care needs. If you’d like to keep your current dentist, check to ensure they will accept your Medicare Advantage plan. If you are seeking a new dentist, check out the Medicare Advantage plan’s dental provider network to make sure dentists are available in your area. 

Types of Medicare Dental Coverage

Medicare Advantage Plans

Medicare Advantage plans include various benefits that are not covered under Original Medicare, such as dental, vision and hearing coverage. Dental coverage purchased through a Medicare Advantage plan ranges from very basic dental coverage to comprehensive dental benefits covering a large range of services.

Basic dental coverage through Medicare Advantage tends to include one or two annual teeth cleanings and dental exams. If you need additional dental coverage to cover more services or more frequent dental appointments, there may be options to increase your dental coverage with an additional premium.

Original Medicare 

Routine dental care is not covered under Medicare Parts A and B (also known as Original Medicare). Dental procedures such as root canals and extractions are also not covered under Original Medicare.

However, you can have certain dental surgeries covered under Part A if you are hospitalized. Complex dental procedures and emergency dental work that must be performed at a hospital will be covered as inpatient care under Part A.

Medicare Supplement Insurance

Medicare Supplement plans help pay for out-of-pocket costs associated with Original Medicare, namely deductibles, copays and coinsurance. Medicare Supplement plans do not specifically offer bundled or standalone insurances like dental and vision, but depending on where you live you may be able to purchase dental coverage as an add-on. 

Medicaid

In the US, 10% of older adults rely on Medicaid to receive dental care, while 28% rely on private dental insurance.

Medicaid or state-level programs may offer dental coverage to low-income Medicare beneficiaries depending on where you live.

What Dental Care Services are Covered by Medicare Advantage?

Medicare Advantage dental coverage varies by plan and location. Typically, Medicare Advantage plans include the following dental benefits:

• Routine Cleanings & Exams
• Tooth Extractions
• Fillings
• X-rays

Depending on the type of plan selected, dental coverage can include just one or two cleanings per year, or offer an annual allowance that covers a variety of dental procedures. 

Many plans also cover more complex procedures, such as:

• Endodontics (Root Canals)
• Periodontics
• Restorative Services
• Prosthodontics
• Other Oral/Maxillofacial Surgery

It’s important to carefully review the coverage details for the plan you are considering, and think about what type of dental work you may need, so you can select a plan that’s right for you.

What are the Costs Associated with Medicare Advantage Plans’ Dental Coverage?

As is the case with overall dental benefits, the costs for each dental service will vary based on the plan. Many Medicare Advantage plans can be purchased with or without dental coverage. In general, plans tend to cover preventive care, such as routine oral exams, cleanings and even certain X-rays at $0. However, you may pay coinsurance or fixed fees for more complex procedures such as root canals, extractions or fillings. Depending on the plan, coinsurance typically ranges between 20% and 70%.

In conclusion, preventive dental care may be available for no cost, while more invasive procedures may require cost-sharing, with fixed copays, or coinsurance. Dental benefits will vary by Medicare Advantage plan, so it is important to review the coverage details to select one that best fits your dental needs. Contact a Baylor Scott & White licensed insurance agent who will help review your dental benefits and find a plan that’s right for you.