Medicare does not cover routine dental care, so you need to buy dental insurance separately
Original Medicare (Parts A and B) does not pay for cleanings, fillings, crowns, root canals, or dentures. If you want dental coverage, you must purchase it on your own — either through a standalone dental plan, a Medicare Advantage plan that includes dental, or by paying out of pocket. The route you choose depends on your budget, how much dental work you expect to need, and whether you already have a Medicare Advantage plan.
This is different from medical coverage. You can have Original Medicare for your doctor and hospital visits, and buy dental insurance from a completely separate company. Many people do exactly this.
Key Takeaways
- Original Medicare does not cover any dental care, so you must buy dental coverage separately unless you switch to a Medicare Advantage plan that includes it.
- Standalone dental plans cost between $100 and $200 per month and typically cover preventive care fully but charge copays or coinsurance for fillings and other procedures.
- Medicare Advantage plans with dental coverage are often available at no extra premium, but you must switch from Original Medicare and accept their network restrictions.
- You can buy a standalone dental plan at any time of year, but you can only switch to a Medicare Advantage plan during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event.
- Most dental plans have a waiting period of 6 to 12 months before they cover major work like crowns or root canals, so the sooner you buy, the sooner coverage begins.
Standalone dental plans: how they work and what they cost
A standalone dental plan is insurance you buy directly from a dental insurance company, separate from your Medicare coverage. You pay a monthly premium (usually $100 to $200), and the plan covers a portion of your dental costs. You can buy one at any time — there is no enrollment window, and you do not have to wait for a specific time of year.
Most standalone plans cover preventive care (cleanings, exams, X-rays) at 100 percent with no copay. For basic procedures like fillings, you typically pay 20 to 50 percent coinsurance after meeting a small deductible (often $25 to $75). Major work like crowns, bridges, and root canals is covered at 50 percent coinsurance, and you usually must wait 6 to 12 months from the date you enroll before the plan will pay for major work.
Most plans also have an annual maximum benefit — often $1,000 to $1,500 per year. Once you reach that limit, the plan stops paying and you pay the rest yourself. Preventive care does not usually count toward this maximum, so cleanings and exams are covered even after you hit the limit.
Medicare Advantage plans with dental: when to choose this route
Some Medicare Advantage plans (also called Part C plans) include dental coverage as part of the plan. Many offer this at no extra premium beyond your regular Medicare Advantage premium. The dental benefit varies widely — some plans cover preventive care only, while others cover basic and major work too.
The trade-off is that you must switch from Original Medicare to the Medicare Advantage plan, which means you use only doctors and hospitals in that plan's network. You also lose the option to buy a Medigap supplemental plan. If your current doctors are in the plan's network and the dental coverage meets your needs, this can be a good choice. If your doctors are out of network or you want the flexibility of Original Medicare, a standalone dental plan may be better.
You can switch to a Medicare Advantage plan only during the annual enrollment period (October 15 to December 7 each year) or if you have a may have access to life event such as moving out of the service area, losing other insurance, or becoming may be able to access for Medicaid. Outside these windows, you cannot switch.
How to find and compare standalone dental plans
You can search for standalone dental plans through several routes. The most direct is to visit insurance company websites directly — companies like Humana, Aetna, Delta Dental, and Cigna all sell dental plans to Medicare beneficiaries. You can also use online brokers like eHealth or GoMedicare, which let you compare plans side by side.
When comparing plans, look at the monthly premium, the deductible, the coinsurance percentages for basic and major work, the annual maximum benefit, and the waiting period for major services. Also check whether your preferred dentist is in the plan's network — out-of-network care usually costs much more. Many plans let you search their dentist directory on their website before you buy.
Read the plan documents carefully, especially the section on exclusions. Some plans do not cover certain procedures like implants or orthodontics. If you know you need specific work, confirm the plan covers it before you enroll.
Waiting periods and when coverage actually starts
Most standalone dental plans have a waiting period before they cover major work. Preventive care (cleanings, exams, X-rays) is usually covered when ready with no waiting period. Basic care (fillings, extractions) often has a waiting period of 6 months. Major care (crowns, bridges, root canals, dentures) typically has a waiting period of 12 months.
This means if you enroll on January 15, you cannot use the plan's major coverage until January 15 of the following year. Some plans waive or shorten the waiting period if you had dental coverage from another plan within the past 12 months — ask the insurance company about this when you enroll.
Because of this waiting period, it is worth buying a dental plan as soon as you know you might need dental work. The sooner you enroll, the sooner the waiting period ends and you can use major coverage.
What to ask your dentist and insurance company before you buy
Before you enroll in any plan, call your dentist's office and ask whether they accept that specific plan. Do not just ask if they accept "dental insurance" — plans vary, and your dentist may accept one company's plan but not another's. Get confirmation in writing if possible.
Ask your dentist what work they recommend for you and what it would cost. Then call the insurance company and ask what the plan would cover for each procedure. Ask specifically about the waiting period, the coinsurance percentage, and whether there are any exclusions that would explore to your situation.
If you are considering a Medicare Advantage plan with dental, call the plan and ask for a list of dentists in your area. Verify that your current dentist is in the network, or find out what dentists are available near you.
Paying out of pocket versus buying insurance
For some people, buying dental insurance costs more than paying for routine care directly. If you only need a cleaning and exam once or twice a year, the monthly premium for insurance may not be worth it. A typical cleaning and exam costs $100 to $200 without insurance, so if you need it twice a year and the insurance premium is $150 per month, you are paying $1,800 per year for insurance to cover $400 in care.
However, if you need a crown, root canal, or other major work, the cost without insurance can be $1,000 to $3,000 or more. A dental plan that covers 50 percent of major work could save you hundreds of dollars on a single procedure. The math changes if you expect major work in the next year or two.
Some dental offices offer discount plans or payment plans for uninsured patients. Ask your dentist whether they participate in a discount dental network or whether they offer a payment plan. This can be cheaper than buying insurance if you only need one or two procedures.
Frequently Asked Questions
Can I have both Original Medicare and a standalone dental plan?
Yes. You can keep Original Medicare for your medical coverage and buy a standalone dental plan from any insurance company. They work independently — the dental plan only covers dental care, and Medicare covers medical care. Many people do this.
What if I switch to a Medicare Advantage plan with dental and then want to go back to Original Medicare?
You can switch back to Original Medicare during the annual enrollment period (October 15 to December 7). Once you switch back, you lose the Medicare Advantage dental coverage. You would then need to buy a standalone dental plan if you want dental coverage. Be aware that a new standalone plan will have its own waiting period for major work.
Do dental plans cover implants?
Most standalone dental plans do not cover implants, or they cover them at a very low percentage. Check the plan's exclusions list before you buy. Some Medicare Advantage plans may cover implants, but this varies by plan — ask the plan directly.
What happens if I need emergency dental work before the waiting period ends?
Emergency care like an extraction for a painful tooth is usually covered even during the waiting period, because it is considered basic care rather than major work. Call your insurance company and your dentist to confirm, but most plans will cover emergency extractions right away.
Can I buy a dental plan if I have no teeth?
Yes, but the coverage will be limited. Most plans cover dentures, but they may have a waiting period or may cover only a portion of the cost. Some plans limit denture coverage to once every five years. Call the insurance company and describe your situation before you buy.