Why Doesn’t Medicare Cover Dental Care?

Why is routine dental care excluded from Original Medicare?

Original Medicare was created mainly to cover hospital and medical care through Part A and Part B. Federal Medicare law has long excluded most routine dental care, including services related to the care, treatment, filling, removal, or replacement of teeth and structures that directly support the teeth.

In practical terms, this means Original Medicare generally treats routine dental care as separate from covered medical care, even though oral health can affect overall health.

What dental services are usually not covered?

In most cases, Original Medicare does not cover common dental services or items such as:

• Routine dental cleanings
• Dental exams and X-rays when they are only for routine dental care
• Fillings
• Tooth extractions, unless an exception applies
• Dentures
• Dental implants

If a dental service is not covered, the person with Medicare is generally responsible for the cost unless another source of coverage applies.

When can Medicare cover dental services?

Medicare can cover certain dental services in limited situations. These exceptions generally apply when the dental service is closely related to the success of a Medicare-covered medical treatment or when the person is admitted as a hospital inpatient for the dental procedure because of an underlying medical condition or the severity of the procedure.

Examples may include certain oral exams and dental treatment before specific covered procedures, such as an organ transplant, kidney transplant, heart valve replacement, or certain cancer treatments. Coverage depends on the facts of the case and whether Medicare requirements are met.

Does Medicare Advantage cover dental care?

Medicare Advantage, also called Part C, is another way to get Medicare coverage. These plans must cover the services that Original Medicare covers, but many also offer extra benefits that Original Medicare does not cover, such as some dental, vision, or hearing services.

Dental benefits in Medicare Advantage vary by plan. A plan may limit covered services, require use of network dentists, set annual benefit limits, or charge copayments or coinsurance. People considering a plan should review the plan’s Evidence of Coverage and provider network before relying on dental benefits.

Does Medigap pay for dental care?

Medigap, also called Medicare Supplement Insurance, helps pay some out-of-pocket costs for services covered by Original Medicare. It generally does not add routine dental coverage.

Because Medigap is designed to supplement Original Medicare rather than create a broad dental benefit, it usually will not pay for routine cleanings, dentures, fillings, or other dental services that Original Medicare does not cover.

What should you check before getting dental care?

Before scheduling dental care, it is wise to ask how the service will be billed and whether it is expected to be covered by Medicare, a Medicare Advantage plan, Medicaid, retiree coverage, or a separate dental plan.

• If you have Original Medicare: ask whether the dental service is directly connected to a covered medical treatment.
• If you have Medicare Advantage: check the plan’s dental rules, network, prior authorization requirements, and cost sharing.
• If the service is not covered: ask the dental provider for a written estimate before treatment.

Official Sources