Quick Look: Best Medicare Dental Plans
Oral health is a critical part of your overall health. It can be an early indicator for diseases, and untreated oral health issues can lead to complications.
Dental coverage under Medicare is limited, however. Learn about Medicare dental plans and your options.
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Are Dental Plans Included With Medicare?
In general, dental plans are not included with Medicare.
Medicare is comprised of 2 parts. Medicare Part A is hospital insurance, which covers inpatient care in hospitals, skilled nursing facility care, hospice care and some home health care. Medicare Part B is medical insurance, and it covers services from health-care providers, outpatient care, durable medical equipment and some home health care.
Medicare Parts A and B also are known as Original Medicare. Original Medicare doesn’t cover most dental care. For example, it doesn’t cover cleanings, fillings, tooth extractions, dentures or dental devices.
Compare Medicare Plans
Let’s take a closer look at Medicare dental coverage.
| Original Medicare | Medigap Policies | Medicare Advantage Plans | |
| What It Is | Medicare Parts A and B | Additional coverage that pays after Medicare Parts A and B | Bundled coverage that provides Medicare Part A and B benefits |
| Cost | You pay for Medicare Part B | You pay for Medicare Part B and the Medigap policy premium | You pay for Medicare Part B, and you may pay a premium for the Medicare Advantage plan |
| Dental Coverage | No coverage for routine dental care | No coverage for routine dental care | May offer dental benefits, but this varies by plan |
Medicare Advantage Plan Dental Coverage
Medicare Advantage plans are a bundled alternative to Original Medicare. These plans provide your Medicare Part A and B benefits, and most also offer Medicare Part D benefits (prescription drug coverage).
Most Medicare Advantage plans also offer benefits that Medicare doesn’t, including dental care. This varies by plan, so it’s essential to review each plan’s benefits carefully before deciding which plan to join.
According to the Kaiser Family Foundation, 92% of Medicare Advantage plans offer dental benefits, but these benefits range from cleanings only to more comprehensive coverage. In addition to ensuring potential plans have dental coverage, look into what that coverage is before selecting a plan.
Dental Coverage on Original Medicare Parts A and B
In general, Original Medicare will not pay for routine dental care. This includes cleanings, fillings, extractions and dentures.
Medicare Part A will pay for certain dental services that you get in a hospital. For example, if you’re in an accident and need oral surgery in a hospital, Medicare will cover the dental care. Medicare Part A also will cover complicated dental procedures that require hospitalization.
Medicare also may pay for oral exams, but not treatment, before a kidney transplant or a heart valve replacement.
Dental Coverage on Medigap
Medigap policies fill the gaps in Original Medicare. They cover many of the copays, deductibles and coinsurance associated with Original Medicare. These plans aren’t designed to cover care that Medicare doesn’t cover except in limited circumstances. For example, some plans cover 80% of foreign travel emergency costs up to plan limits.
If Medicare doesn’t cover something, Medicare Supplement plans won’t cover it either. This extends to dental care. Medicare Supplement plans won’t cover routine dental care, but they will help with the costs of any dental surgeries or exams covered by Medicare.
Getting Dental Care When You Have Original Medicare
How do you pay for dental care if you have Original Medicare with or without a Medicare Supplement? One option is to buy a dental insurance plan. These plans are sold by private insurance companies.
With these plans, you pay a monthly premium. Dental insurance plans vary, but in general they cover:
- Preventive care: This includes exams, regular cleanings and x-rays, fluoride treatments and sealants.
- Basic restorative care: This includes fillings, non-routine x-rays and simple extractions.
- Major restorative care: This includes bridges, crowns, dentures and more complicated extractions.
Implants may or may not be covered depending on the plan. Dental plans also typically have:
- A deductible: This is the amount you pay for covered services before your insurance plan starts to pay.
- Copays: This is a fixed amount you pay for a service. For example, you might pay $20 for an office visit.
- Coinsurance: This is a percentage you pay for a service. You might pay 20% of the cost of a filling.
- Plan limits: This is the most your plan will pay in dental benefits annually.
You can find dental insurance plans by contacting dental insurance companies directly. You may also be able to enroll through your state’s Health Insurance Marketplace.
Another option for dental care is purchasing a dental savings plan, which also may be called a dental discount plan. With these plans, you pay an annual membership fee. You receive a membership card to present to participating dentists for a discount on their services.
These plans aren’t insurance, so there aren’t any deductibles or copays. You receive the discount at the time of service, and there isn’t a limit on how often you use the discount.
Which Dental Plan Is Right for You?
Dental care is essential for good health. Which plan is best? If you have Original Medicare with or without a Medigap policy, a dental insurance or discount plan can help you with dental costs. If you’re looking for an all-in-one solution, a Medicare Advantage plan with dental coverage might be a good fit.
Review your options carefully, and if you’re uncertain, contact your local State Health Insurance Assistance Program (SHIP). These programs offer free, unbiased advice on Medicare and related plans.
Frequently Asked Questions
Is it mandatory to go on Medicare when you turn 65?
Medicare isn’t mandatory when you turn 65. However, most people do start Medicare Part A at 65. The reason is that most people don’t pay a premium for Medicare Part A, so there’s no reason to wait to sign up. If you have employer coverage, your employer may want you to enroll in Medicare Part A. If you’re uncertain, ask your human resources department how to proceed.
If you have employer coverage or coverage through a spouse, you may want to wait to enroll in Part B until you no longer have coverage. This option varies by employer size.
You pay a premium for Medicare Part B. Just be sure to enroll in Part B as soon as your coverage ends. If you don’t enroll in Medicare Part B when you’re first eligible and you have a gap in coverage, you could pay a late enrollment penalty.
Medicare offers special enrollment periods if you lose other coverage. It also offers annual enrollment periods if you didn’t enroll earlier.
Can I have both employer insurance and Medicare?
You can have both employer insurance and Medicare. You may need to sign up with Social Security to get Medicare if you’re not already receiving Social Security benefits. Your human resources department or plan provider can advise you whether to just get Part A or whether to get Parts A and B.
In general, if your employer has fewer than 20 employees, you should sign up for both parts when you turn 65. If your employer has 20 or more employees, you may be able to delay getting Parts A and B. The best course of action depends on your individual situation and your employer, so don’t hesitate to ask what your employer recommends.