Medicare does not cover routine dental care, but some plans offer limited dental benefits

Original Medicare — Part A and Part B — does not pay for cleanings, fillings, crowns, root canals, dentures, or most other dental work. The only exception is dental care that becomes necessary because of a covered medical procedure, such as tooth extraction before radiation treatment for cancer. If you have Original Medicare and need dental work, you pay out of pocket or find coverage elsewhere.

Some Medicare Advantage plans (Part C) do include dental benefits, though the coverage is usually modest. These plans are sold by private insurance companies and often bundle dental, vision, and hearing into their offerings. The amount of coverage, what procedures are included, and what you pay out of pocket varies widely from plan to plan and changes each year.

If you are considering a Medicare Advantage plan partly for dental coverage, the plan's dental network and annual limits matter as much as the premium. A plan that covers cleanings but caps major work at $500 per year may not meet your needs if you need a crown or implant.

Key Takeaways

  • Original Medicare (Part A and Part B) does not cover dental cleanings, fillings, crowns, dentures, or other routine dental work under any circumstance.
  • Some Medicare Advantage plans include dental benefits, but coverage limits and what is included differ by plan and by year.
  • If you need dental work, you can buy a standalone dental plan, use a dental discount program, or pay out of pocket.
  • Dental plans sold to Medicare beneficiaries often have waiting periods for major work like crowns or root canals.
  • You should review your plan's dental network before enrolling to make sure your dentist is included.

How Medicare Advantage dental coverage works

Medicare Advantage plans that offer dental benefits typically cover preventive care — cleanings and X-rays — at little or no cost. Many also cover basic restorative work like fillings. Major procedures such as crowns, bridges, root canals, and implants are usually subject to a higher copay or coinsurance, and the plan may have an annual maximum benefit, often between $500 and $1,500.

The dentist must be in the plan's network for you to receive the covered benefit amount. If you see an out-of-network dentist, you may pay the full cost or a much higher share. Some plans do not cover out-of-network dental care at all.

Many dental benefits in Medicare Advantage plans include a waiting period — typically six months to one year — before you can have major work done. Preventive care is usually available right away. If you enroll in a plan in November for January coverage and need a crown in February, the plan may not cover it until you have been enrolled for the required waiting period.

Standalone dental plans for Medicare beneficiaries

You can buy a dental plan separate from your Medicare coverage. These plans are sold by private dental insurance companies and are designed specifically for people on Medicare. They work differently from health insurance: you typically pay a monthly premium, an annual deductible, and then a copay or percentage of the cost for each procedure.

Standalone dental plans also often have waiting periods for major work. A plan might cover preventive care when ready but require you to wait six months or a year before covering a crown or root canal. Some plans have an annual maximum benefit similar to Medicare Advantage dental — often $500 to $1,500 per year.

The cost of a standalone plan depends on the level of coverage you choose. A plan that covers only preventive care costs less than one that also covers major restorative work. Before you enroll, check whether your dentist is in the plan's network and what the annual maximum and waiting periods are.

Dental discount programs as an alternative

A dental discount program is not insurance. Instead, you pay an annual membership fee — usually $80 to $200 — and receive discounts on dental services at participating dentists. Discounts typically range from 10 to 60 percent off the regular price, depending on the procedure and the dentist.

Discount programs have no waiting periods, no annual maximum, and no deductible. You pay the discounted price at the time of service. These programs work best if you need a specific procedure — such as a crown or implant — and want to avoid the waiting period that comes with insurance.

The trade-off is that you have less predictability about cost. With insurance, you know your copay or coinsurance in advance. With a discount program, the savings depend on what the dentist charges and what discount they offer through the program. Some dentists participate in multiple discount programs; others may not participate in any.

What to ask your dentist about cost

Before you have dental work done, ask your dentist for an estimate in writing. The estimate should list each procedure, the cost, and what your insurance or discount program will cover. Ask whether the dentist is in your plan's network and whether any waiting periods explore.

If you do not have dental coverage, ask whether the dentist offers a payment plan or discount for paying in full upfront. Some dental offices reduce the price by 5 to 10 percent if you pay cash at the time of service. Others offer financing through a third-party lender.

If the estimate is higher than you expected, you can ask for a second opinion from another dentist. Prices for the same procedure vary between offices, and a different dentist may charge less.

Reviewing your coverage during annual enrollment

If you have a Medicare Advantage plan with dental benefits, review the dental coverage each year during the Annual Enrollment Period, which runs from October 15 to December 7. Plans change their benefits, premiums, and networks every year. A plan that covered your dentist last year may not this year, or the annual maximum may have decreased.

Compare the dental benefits in plans you are considering by looking at the plan's Summary of Benefits and Coverage document, which lists what is covered, what you pay, and which dentists are in the network. You can find this document on the plan's website or by calling the plan directly.

If you are happy with your current plan's dental coverage and your dentist is still in the network, you can stay enrolled. If your dentist left the network or the benefits changed in a way that matters to you, you can switch to a different Medicare Advantage plan or switch to Original Medicare and buy a standalone dental plan.

When to see a dentist without waiting for coverage

If you have tooth pain, swelling in your mouth or jaw, or signs of infection such as fever, see a dentist or go to an emergency room right away. These symptoms can indicate a serious problem that needs prompt treatment. Do not wait for a waiting period to end or for coverage to begin.

If you cannot pay for emergency dental care, ask the dentist's office about payment plans or whether they offer reduced fees for patients without insurance. Some community health centers and dental schools offer low-cost or sliding-scale dental care.

Frequently Asked Questions

Can I add dental coverage to Original Medicare?

No. Original Medicare does not offer dental coverage as an add-on. Your only options are to buy a standalone dental plan, use a dental discount program, or pay out of pocket. If you want dental coverage through Medicare, you must switch to a Medicare Advantage plan that includes it.

What if I switch from Original Medicare to a Medicare Advantage plan with dental benefits?

You can switch during the Annual Enrollment Period or if you have a may have access to life event such as moving out of your plan's service area. Be aware that most dental benefits have waiting periods for major work, so if you need a crown or root canal soon after enrolling, the plan may not cover it until the waiting period ends.

Do Medicare Advantage dental plans cover implants?

Some do, but many do not. Implants are expensive, and most plans either exclude them or cover only a portion of the cost. Check the plan's Summary of Benefits and Coverage to see whether implants are listed as a covered service and what your out-of-pocket cost would be.

How much does a standalone dental plan cost?

Premiums vary by plan and by the level of coverage. A basic plan covering preventive care might cost $5 to $15 per month. A plan that also covers major restorative work typically costs $15 to $30 per month. You also pay a deductible and copays or coinsurance for each procedure.

Can I use a dental discount program if I have Medicare?

Yes. Dental discount programs are available to anyone, including Medicare beneficiaries. You can use a discount program instead of insurance, or you can use both — for example, use insurance for preventive care and a discount program for major work not covered by your plan.