A common question many people who receive Medicare have is: does Medicare cover dental care services? Dental care becomes even more important as you age as you become more prone to dental issues and diseases. Many Americans lose their dental insurance when they lose their employer benefits upon retirement. Read on to find out if Medicare covers dental and how you can get covered.
Common Dental Problems as you age
Good oral hygiene and regular dental care are critical to helping prevent complications with your overall oral health as you age. In particular, as you grow older your teeth and gums become less sensitive and you may not notice a problem until it is too late.
It’s important to try to find appropriate dental coverage when you are older. Common problems associated with dental care when aging include:
- Dry Mouth: Older adults are more at risk for dry mouth. This can occur because of age, medicine use, or certain health conditions. Dry mouth is a common side-effect for over 500 medications including those that cover allergies or asthma, high blood pressure, high cholesterol, pain, anxiety or depression, Parkinson’s, and Alzheimer’s diseases. The problem with reduced saliva production is that sugar and acids build up more readily in the mouth, resulting in an increased chance of cavities
- Gum Disease: Gum disease is caused by multiple factors like plaque or food left in teeth, the use of tobacco products, poor-fitting bridges and dentures, poor diets, and certain diseases such as anemia, cancer, and diabetes. This is often a problem for older adults and can cause receding gums which is when your gum tissue pulls away from the tooth, exposing the base or root.
- Root decay: If untreated, gum disease and receding gums can lead to root decay and ultimately tooth loss. This is caused by exposure of the root to decay which leads to the production of acids. The roots then become exposed as gum tissue recedes from the tooth. Roots do not have any enamel to protect them and are more prone to decay than the crown.
- Oral Cancer: According to the American Cancer Society, there are about 35,000 cases of mouth, throat, and tongue cancer diagnosed each year. The average age of people diagnosed with these cancers is 62. During dental visits, your dentist will check for any signs of oral cancer. Regular dental visits are important because the early stages of oral cancer typically do not cause pain and early detection saves lives.
Does Original Medicare Cover Dental Care?
Original Medicare will not cover most dental care, dental procedures, or supplies.
The only way that Original Medicare will cover dental care expenses is if you go through a traumatic injury that causes an impact to your oral health. In this scenario, Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you’re in a hospital. Part A can pay for inpatient hospital care if you need to undergo an emergency or complicated dental procedure, even though dental care isn’t covered.
Since Original Medicare doesn’t cover routine dental care, it will also not cover things like dentures. So for example, if you needed to have your teeth removed they would cover the cost of the surgery but they will not cover the cost of getting replacements.
Does Medicare Advantage cover Dental Care?
Depending on which plan you choose, Medicare Advantage plans (also known as Medicare Part C), are “all-in-one” packages that include Part A, B, and sometimes D (drug coverage) as well as extra benefits which may not be covered by Original Medicare, like dental care.
In 2023, 97% of Medicare Advantage plans have some sort of dental coverage. These plans will often include routine and preventatives services such as regular oral exams and check-ups, teeth cleaning, fluoride treatment, x-rays, extractions, fillings, and possibly more. Certain plans may offer more comprehensive coverage and help cover things like dentures as well.
While many Medicare plans offer routine dental coverage, the specific details and coverage limitations will vary across different plans. It is considered best practice to compare all the plans in your area to determine which one offers the best dental coverage for you. Please keep in mind you may also have to use a provider within the plan’s network in order to be covered.
Medicare Advantage plans that include dental coverage could have a ‘$0 premium’ (in other words no additional premium over your standard Part B premium). There also may be an annual limit on Medicare Advantage dental coverage between $500 up to $4,000.
These plans may cover anything from routine cleanings to dental implants depending on the plan. For more comprehensive dental coverage to be included, you may be required to pay an additional monthly premium.
Does Medigap Cover Dental Care?
Since Original Medicare does not have any coverage on routine dental care, Medigap will not be covering any routine care as well. Medigap plans are designed to only help cover out-of-pockets costs for services that Original Medicare will also cover.
Original Medicare does however cover dental care if it is medically necessary. Meaning if you suffered an emergency illness, trauma, or injury that affects your oral health, Medigap plans will be able to cover those services along with your out-of-pocket cost as long as Original Medicare will also cover those costs. What is covered will be dependent on the type of plan you purchase.
How else can I get Dental Care coverage?
While Medicare Advantage plans are a convenient way to get dental coverage for those over 65 or otherwise eligible for Medicare. Other ways to get dental care coverage include:
- Buying a separate or standalone dental plan: These can be purchased from a private insurance company and many basic dental plans will offer you coverage for preventive dental care with affordable monthly premiums. Other plans may provide comprehensive dental coverage for a higher premium. Standalone dental plans usually include deductibles, copays, and coinsurance.
- Health Savings Account (HSA): Before age 65, you may consider opening an HSA if you have a high deductible health plan (HDHP). Once you enroll in Medicare you can no longer contribute to the HSA but you can use what you’ve saved to help pay for covered expenses which include dental care.
- Look for an affordable walk-in dental clinic in your area: You may be able to find affordable dental care even if it means paying out-of-pocket around where you live. Call and do research. Your state department may also have information on where you can get low-cost dental services.
Final Words
As you age, dental care becomes more important. For the most part, Original Medicare does not cover routine dental care. 97% of Medicare Advantage (Part C) plans have some form of dental coverage which includes coverage for routine and preventative dental care services. Coverage varies by Medicare Advantage plans so it is best practice to compare all the ones in your area to determine which plan offers the dental coverage that suits you best.
At CoverRight, we’re here to help you find the right coverage that you deserve. Reach out today and start finding the right Medicare plan for you.
