Table of Contents:
- Dental Services and Medicare
- Medicare Advantage
- Stand-Alone Dental Plans
- More Resources
- The Future of Medicare and Dental Coverage
Since its introduction in 1965, Original Medicare (Part A and Part B) has covered a range of medically-necessary services while excluding certain services that some beneficiaries may use routinely and want covered. Nearly all dental services are not included.
Dental Services and Medicare
Dental services range from simple checkups and cleanings to cavity fillings, tooth extractions, x-rays, and the creation of customized dental devices (such as dentures, dental plates, and crowns). Certain dental services are covered by Part A plans. For example, Medicare Part A may cover emergency reconstructive surgery following an accident. It would not, however, extend to the care a beneficiary receives during a routine examination.
Dental costs are on the rise. From 1990 to 2016, average per-capita spending on dental care rose 81%, even after adjusting for inflation. Nearly two thirds of Medicare beneficiaries have no form of dental coverage. There are a range of options available to beneficiaries who want to supplement their Original Medicare coverage with dental benefits.
Medicare Advantage plans are Medicare-approved health insurance plans from private carriers that cover all the same services as your Part A and Part B plans, as well as other services that Original Medicare does not cover. In 2021, the majority (92%) of Medicare Advantage plans provide dental benefits.
Stand-Alone Dental Plans
Stand-alone dental plans (SADPs) are plans that only supplement Original Medicare in the sense that they cover some or all of a beneficiary’s dental expenses. Depending on the plan, an SADP may present lower premiums or a more manageable cost-sharing model than a Medicare Advantage plan with dental coverage.
If your annual income is below your state’s Medicaid threshold, you qualify for Medicaid. Medicaid is completely free and can save you a considerable amount of money on health-related expenses. It is possible to have both Medicare and Medicaid coverage simultaneously. In these instances, Medicaid pays after Medicare. Take care to confirm that your dentist accepts Medicaid.
If you are without dental coverage, do not qualify for Medicaid, and are facing exorbitant dental expenses, there are several options available to you. You could search for free or reduced-cost dental clinics in your area, dental schools, or donated dental service programs.
The Future of Medicare and Dental Coverage
There have been numerous attempts to add basic dental coverage to Original Medicare’s scope. Recent “Medicare for All” proposals, for example, have called to create a single federal health plan with coverage for a range of services, including both routine and emergency dental care. So far, no proposal has been successful.
Additional information and cost data adapted from the American Dental Association and the Kaiser Family Foundation
U.S. Dental Expenditures, ADA. 2017
Medicare for All: What Is it and How Will it Work?, Healthline, 2020