Most dentists do not accept Medicare, and Medicare itself covers very little dental work
Original Medicare — the federal program run by the Centers for Medicare & Medicaid Services — does not pay for routine dental care, cleanings, fillings, or dentures. The only dental services Medicare covers are tooth extractions and other oral surgery when they are medically necessary before a hospital procedure or radiation treatment for cancer of the jaw or mouth. If you need a dentist for anything else, you will pay out of pocket or through a separate dental plan.
Some Medicare Advantage plans (Part C) do include dental coverage, but the scope and cost vary widely by plan and by region. If you have a Medicare Advantage plan, your plan documents will tell you whether dental is included and which dentists are in your network. If you have Original Medicare, you have no dental coverage through Medicare itself, though you can buy a standalone dental plan from a private insurer.
Key Takeaways
- Original Medicare does not cover routine dental care, cleanings, fillings, crowns, or dentures under any circumstances.
- Some Medicare Advantage plans include dental coverage, but you must check your specific plan's documents to see what is covered and which dentists participate.
- If you have Original Medicare and want dental coverage, you can purchase a standalone dental insurance plan from a private company.
- Dentists who accept Medicare Advantage dental coverage are listed in your plan's provider directory, which you can find on your plan's website or by calling the plan's customer service number.
What Original Medicare covers and does not cover
Original Medicare Part A and Part B do not include a dental benefit. This means Medicare will not pay for cleanings, exams, X-rays, fillings, root canals, crowns, bridges, dentures, or implants. The only exception is oral surgery that is medically necessary — for example, tooth extraction before heart surgery, or jaw surgery related to a covered medical condition.
If your dentist determines that a tooth must be removed for medical reasons before a hospital procedure, Medicare may cover the extraction if your doctor orders it as part of your hospital care. You would need documentation from your hospital or surgeon showing the extraction is medically necessary. Routine extractions for decay or gum disease are not covered.
How to find dentists in a Medicare Advantage plan
If you are enrolled in a Medicare Advantage plan that includes dental coverage, your plan will have a network of dentists who have agreed to accept that plan's payment rates. To find a participating dentist, start with your plan's provider directory. This is usually available on the plan's website, or you can call the customer service number on your insurance card.
When you call or search online, ask specifically for dentists who participate in your plan's dental network. Not all dentists in your area will be in the network, and using an out-of-network dentist may cost you more or may not be covered at all. Many plans require you to choose a primary dentist, similar to how you choose a primary care doctor. Check your plan documents for any referral requirements before scheduling an appointment.
What Medicare Advantage dental plans typically cover
Medicare Advantage dental benefits vary by plan and by year. Some plans cover only preventive care — cleanings, exams, and X-rays — at no cost to you. Others cover basic restorative work like fillings. A smaller number cover major services like crowns, bridges, or root canals, but usually with a higher out-of-pocket cost and an annual maximum benefit.
Most Medicare Advantage dental plans have an annual limit on what they will pay for dental services. This limit might be $500, $1,000, $1,500, or another amount depending on the plan. Once you reach that limit, you pay the full cost of any additional dental work for the rest of that calendar year. Your plan documents will show your annual maximum, any waiting periods for major services, and your copay or coinsurance amounts.
Buying a standalone dental plan if you have Original Medicare
If you have Original Medicare and want dental coverage, you can purchase a standalone dental insurance plan from a private insurance company. These plans are sold directly to individuals and are not part of Medicare. You pay a monthly premium, and the plan covers a portion of your dental costs up to an annual maximum.
Standalone dental plans typically have waiting periods — often six months to one year — before they cover major services like crowns or root canals. Preventive care is usually covered when ready with no waiting period. Plans vary in their monthly cost, annual maximum, and what percentage of the bill they cover. You can compare plans through insurance brokers, insurance company websites, or your state's health insurance marketplace.
What to do if your dentist does not accept your plan
If your dentist does not participate in your Medicare Advantage dental network, you have a few options. You can ask your dentist whether they will accept your plan's payment rate as full payment. Some dentists who are not officially in the network will do this as a courtesy. You can also ask your plan whether it will cover out-of-network care and at what percentage.
If your dentist will not accept your plan's rate and your plan will not cover out-of-network care, you will need to pay the full cost yourself or switch to a dentist in your plan's network. Before making a change, call your plan's customer service line to confirm whether your current dentist is truly out of network and what your coverage would be if you see them.
Dental coverage during the Medicare Advantage open enrollment period
If you currently have a Medicare Advantage plan with little or no dental coverage and you want better dental benefits, you can switch to a different plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. During this time, you can compare all Medicare Advantage plans available in your area and choose one with the dental coverage you need.
When comparing plans, look at the dental benefit details, not just the monthly premium. A plan with a lower premium might have a lower annual maximum or longer waiting periods for major services. Check whether your preferred dentist is in the network of the new plan before you switch. If you miss the Annual Enrollment Period, you generally cannot change plans until the next year unless you may have access to for a Special Enrollment Period due to a life event.
Frequently Asked Questions
Does Medicare cover dental implants?
No. Medicare does not cover dental implants, implant surgery, or the abutments and crowns that go on implants. If you have a Medicare Advantage plan with dental coverage, check your plan documents to see whether implants are covered — most plans do not cover them, or cover only a small percentage of the cost.
Can I use my Medicare Advantage dental benefit at any dentist?
No. You must use a dentist who is in your plan's network to receive the plan's coverage. If you see an out-of-network dentist, you may have to pay the full cost yourself. Always check your plan's provider directory before scheduling an appointment.
What if I need emergency dental work on a weekend?
Call your Medicare Advantage plan's customer service line — the number is on your insurance card — and ask for emergency dental coverage information. Some plans cover emergency extractions or pain relief at urgent care or emergency rooms. Original Medicare does not cover emergency dental care unless it is part of a hospital admission for a medical condition.
Do I have to pay for dental work upfront and then get reimbursed?
If you see a dentist in your Medicare Advantage plan's network, the dentist will bill your plan directly and you will pay only your copay or coinsurance at the time of service. If you see an out-of-network dentist, you may have to pay the full bill upfront and then submit a claim to your plan for reimbursement, if the plan covers out-of-network care at all.
Can I switch dentists if my current dentist leaves my plan's network?
Yes. If your dentist leaves your plan's network, you can choose a different in-network dentist at any time. Call your plan's customer service line to find another dentist near you, or search your plan's online provider directory. You do not have to wait for the Annual Enrollment Period to change dentists.