Does Medicare Cover Dental? What Is and Isn’t Covered

One of the most common surprises at age 65 is learning that Original Medicare does not cover most dental care. If you have relied on employer dental insurance for years, the gap can be a shock. This guide explains, in plain language, what Medicare does and does not pay for, the narrow medical situations where dental care can be covered, and the other places people with Medicare look for dental coverage.

Key takeaways

• Original Medicare (Parts A and B) does not cover most routine dental care, dentures or implants.
• It can cover some dental care linked to specific medical treatments or hospital stays.
• Some Medicare Advantage plans add dental benefits, and some states cover dental care for people with both Medicare and Medicaid.
• Dental schools and health centers offer lower-cost care.

Medicare rules and costs change, so treat this as a starting point and confirm details with Medicare or your plan.

The short answer

Medicare.gov says that in most cases Medicare does not cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures and implants, and that you pay all costs for non-covered services, including most dental services (Medicare.gov: Dental services).

The federal Centers for Medicare & Medicaid Services (CMS) explains the legal basis: Medicare law excludes items and services for the care, treatment, filling, removal or replacement of teeth or the structures directly supporting the teeth (CMS: Medicare Dental Coverage). CMS lists routine dental care and extraction of an impacted tooth among its examples of non-covered services.

When Original Medicare can cover dental care

There are exceptions, but they are tied to your medical care rather than ordinary dental needs.

Hospital stays

According to Medicare.gov, Medicare may cover some dental services you get when you are admitted as a hospital inpatient for your dental procedure, either because of your underlying medical condition or because of the severity of the procedure. CMS describes the same exception for inpatient hospital services.

Dental care linked to a covered medical treatment

CMS says the dental exclusion does not apply when dental services are “inextricably linked” to the clinical success of other Medicare-covered services. Examples listed by Medicare.gov and CMS include:

• An oral exam and dental treatment before a heart valve replacement, or before a bone marrow, organ or kidney transplant.
• A procedure, such as an extraction, to treat a mouth infection before cancer treatment like chemotherapy. CMS also lists CAR T-cell therapy and high-dose bone-modifying (antiresorptive) drugs used to treat cancer.
• Exams and treatment related to head and neck cancer treatment, including care for dental complications.
• Dental or oral exams, and treatment to remove an oral infection, before and during Medicare-covered dialysis for end-stage renal disease (ESRD).
• Services to stabilize teeth when treating a jaw fracture, and dental splints used as part of covered treatment such as for dislocated jaw joints.
• Dental ridge reconstruction done at the same time as surgery to remove a tumor.

CMS notes that for these services to qualify, the doctor and dentist must coordinate care, and that coordination must be documented in the medical record. If you are facing one of these treatments, ask both your medical team and your dentist whether the dental work qualifies before it is done.

What you pay when it is covered

Medicare.gov says that for Part B-covered dental services, you pay 20% of the Medicare-approved amount after you meet the Part B deductible, and you may also pay a copayment if you get the service in a hospital outpatient setting. For covered inpatient stays, Part A cost-sharing applies. Medicare.gov lists the current-year Part A amounts on the same page; check it for the latest figures, since they change each year.

Other ways people with Medicare get dental coverage

Medicare Advantage (Part C)

CMS notes that some Medicare Advantage plans may cover routine and other dental services as an added benefit, and that you should check with your plan to find out what it covers. Plans differ a lot. When comparing plans, look at:

• Which services are included (exams, cleanings, X-rays, fillings, extractions, dentures, crowns).
• Annual maximums and how much you pay per service.
• Whether you must use a dental network.
• Waiting periods or frequency limits.

Medicaid for people who qualify for both

CMS says some states may cover routine and other dental services for people who are dually eligible for Medicare and Medicaid, and suggests checking with your state Medicaid agency. Our Medicaid dentist finder and our guide to dentists that accept Medicaid can help.

Stand-alone dental insurance or discount plans

Some people buy a separate dental policy or join a dental discount plan. They work differently: insurance pays part of the cost of covered services, while a discount plan gives you reduced fees at participating dentists. Read our comparison of dental insurance and discount plans and the basics of how dental insurance works. Our dental insurance glossary explains terms like annual maximum and waiting period.

Low-cost clinics

The National Institute of Dental and Craniofacial Research (NIDCR) points to dental schools, dental hygiene schools and community health centers as sources of reduced-cost care (NIDCR: Finding Dental Care). See our guide to dental school clinics and our page on low-cost dental care.

Practical tips before treatment

• Ask for a written estimate. Medicare.gov encourages asking your provider how much a service will cost, and asking why a service Medicare does not cover is being recommended. Our guide on how to read a dental treatment plan walks through an estimate line by line.
• Check plan details during enrollment. If dental coverage matters to you, compare it during your plan’s enrollment window.
• Do not wait on an infection. Swelling, fever or a severe toothache can signal an abscess. See our article on signs of a dental abscess.
• Keep up with prevention. Daily brushing with fluoride toothpaste, cleaning between teeth and regular checkups help avoid bigger, costlier problems. Our article on dry mouth and your teeth covers a common issue for people who take several medications.

Questions to ask a Medicare Advantage plan about dental

• Is dental included in the plan, or is it an optional add-on with its own premium?
• Which services are covered as preventive, basic and major care?
• Is there an annual maximum, and does it reset every calendar year?
• Do I have to use dentists in a network, and is my current dentist in it?
• Are there waiting periods before major services such as crowns or dentures?
• How often are cleanings, exams and X-rays covered?

Write down the answers, and compare them with what you expect to need in the next year, not just with the premium.

Frequently asked questions

Does Medicare cover dental cleanings?

Not under Original Medicare. Medicare.gov lists routine cleanings among the services Medicare does not cover in most cases. Some Medicare Advantage plans include them.

Does Medicare cover dentures or implants?

In most cases, no. Medicare.gov names dentures and implants as items Original Medicare does not cover. Check a Medicare Advantage plan’s dental benefit if you need them.

Will Medicare pay for a tooth extraction?

Usually not. An exception is when the extraction is needed to treat an infection before a covered treatment such as chemotherapy or an organ transplant, with care coordinated between your doctor and dentist.

Where can I check what my plan covers?

Call your Medicare Advantage plan or read its Evidence of Coverage. For Original Medicare, see the Medicare.gov dental services page or call Medicare.

Sources

• Medicare.gov – Dental services
• CMS – Medicare Dental Coverage
• NIDCR – Finding Dental Care

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Smiling senior woman with curly hair portrait” by Shixart1985, via Wikimedia Commons, licensed CC BY 2.0. Resized and compressed for the web.