While Medicare does cover much more preventive care than many people realize, original Medicare (Part A and Part B) does not cover routine dental services and procedures in most cases. It’s important to understand what is not covered and explore your options for Medicare dental plans if you want to have dental coverage once you are on Medicare. Medicare and Dental: What You Need To Know
Medicare’s Coverage of Dental
First and foremost, you should understand that your regular dentist check-ups and any related services and procedures would not be covered under Medicare. Part B of Medicare is the part that covers anything outpatient, and Part B does not cover any dental.
There are very few situations in which Part A of Medicare (inpatient/hospital) would pay for dental surgeries if you are hospital-confined and need surgery as a part of another medical procedure. For example, Part A may cover a tooth extraction in preparation for radiation.
Overall, though, you should know that, if you go to the dentist once or twice a year, regular Medicare is not going to pay a dime for those visits. Likewise, if you have more frequent (and expensive) dental needs, such as fillings, crowns, or dentures, Medicare will not pay anything towards that.
Options for Medicare Dental Coverage
So, since Medicare itself does not provide any coverage for dental, what are your options? The good news is that you do have a few options to choose from if you still want to have dental coverage once you go on Medicare.
The first option is that you can purchase a stand-alone Medicare dental plan. There are about 5-10 companies that sell these in most states for people on Medicare. These plans can give you some coverage for regular check-ups as well as paying a percentage, usually after a waiting period, towards more comprehensive services and procedures. Premiums for this type of stand-alone dental coverage can vary greatly, but typically, you can get a dental plan for $20-40/month.
Another option is that you can go on a Medicare Advantage plan. Medicare Advantage plans are privatized versions of traditional Medicare, some of which include some minimal coverage for dental. Note that this type of plan takes the place of Medicare, so you should certainly look at all the benefits, restrictions, and long-term implications – don’t just choose to go with this type of plan because it covers a dental check-up once a year.
Lastly, you can choose to be a cash payer for dental once you go on Medicare. This is actually what the majority of people end up doing. Often, you can get a better price by paying cash for your dental services and procedures, and all you have to do is ask. This can be a good option if you are a minimal user of dental services.
Other Considerations for Medicare and Dental
One important thing to keep in mind when considering whether you should purchase additional coverage for dental once you go on Medicare is the waiting periods that these plans often have.
While these plans do not typically have underwriting (i.e. ask you medical questions when you apply), they do typically have waiting periods. This means that certain services and procedures would not be covered for a specified time (usually a few months). So, when your dentist tells you that the only way to eliminate your severe tooth pain is to do an expensive dental procedure, it’s too late to purchase dental insurance at that time.
Although Medicare does not cover routine dental care and procedures, you can still protect yourself by planning ahead. Look at your options to see if it is worthwhile to purchase a stand-alone dental plan. Or if you decide not to purchase a plan, you can budget for dental monthly, then be a cash payer with resources available when you need them.