Medicare does not cover routine dental care, but some dental services may be covered if they are medically necessary
Original Medicare (Part A and Part B) does not pay for cleanings, fillings, crowns, bridges, dentures, or root canals. This is one of the largest gaps in Medicare coverage. If you need dental work, you will pay the full cost yourself unless you have a separate dental plan.
There is one important exception: Medicare Part B may cover dental services that are part of a covered medical procedure. For example, if you need tooth extraction before jaw surgery, or if you need dental care as part of treatment for cancer of the mouth or jaw, Medicare may cover the dental portion. The dental work must be directly tied to the medical condition and performed by a dentist or physician in a hospital or outpatient setting.
Medicare Advantage plans (Part C) sometimes include dental coverage, but the scope and cost vary widely by plan. Some plans cover cleanings and exams; others cover major work like crowns. You need to check your specific plan's details.
Key Takeaways
- Original Medicare does not cover routine dental care such as cleanings, fillings, or dentures under any circumstances.
- Medicare Part B may cover tooth extraction or other dental work if it is medically necessary as part of a covered medical procedure.
- Some Medicare Advantage plans include dental coverage, but benefits differ by plan and by year.
- You can purchase a standalone dental plan from a private insurance company to cover routine dental care.
- Federally may have access to health centers and dental schools sometimes offer low-cost or sliding-scale dental services to Medicare beneficiaries.
When Medicare Part B covers dental work
Medicare Part B covers dental services only when they are integral to a covered medical treatment. The dental work must be performed in a hospital or ambulatory surgical center, and the underlying medical condition must be one Medicare covers.
Examples include tooth extraction before radiation therapy for oral cancer, or dental work needed before heart surgery if the dental infection poses a risk to the surgical outcome. In these cases, the dentist or oral surgeon must document that the dental procedure is medically necessary and directly related to the covered medical condition.
To find out whether your specific dental need qualifies, contact Medicare at 1-800-MEDICARE or ask your doctor whether the dental work is part of a covered medical procedure. Do not assume it will be covered; get written confirmation before you have the work done.
Dental coverage in Medicare Advantage plans
About 70 percent of Medicare Advantage plans include some form of dental coverage, but the benefits are not standardized. One plan may cover two cleanings and one exam per year; another may cover cleanings, exams, and basic fillings; a third may include major restorative work like crowns or root canals, usually with a higher out-of-pocket cost.
Dental benefits in Medicare Advantage plans often come with annual maximums — typically $500 to $1,500 per year. Once you reach that limit, you pay the full cost of any additional dental work. Some plans also require you to use dentists in their network.
If dental coverage is important to you, compare the dental benefits in different Medicare Advantage plans during the annual enrollment period (October 15 to December 7 each year). Your dental needs may change from year to year, so review your plan's coverage each fall before the new year begins.
Standalone dental plans for Medicare beneficiaries
You can purchase a dental plan directly from a private insurance company, whether you have Original Medicare or a Medicare Advantage plan. These plans are separate from Medicare and are not subsidized by the government.
Standalone dental plans typically cost $100 to $200 per month and cover preventive care (cleanings and exams), basic care (fillings and extractions), and major care (crowns, bridges, root canals). Most plans have an annual maximum benefit of $500 to $1,500. Many plans also have a waiting period of 6 to 12 months before they cover major work, so you cannot buy a plan and when ready use it for expensive procedures.
You can enroll in a standalone dental plan at any time of year, unlike Medicare itself. Compare plans on the websites of major insurers such as Humana, Delta Dental, and Cigna, or use a broker site to see multiple options side by side. Read the fine print carefully: some plans exclude certain procedures or have high copayments for major work.
Low-cost dental care options
If you cannot afford a dental plan, federally may have access to health centers (FQHCs) in your area may offer dental services on a sliding fee scale based on your income. These are community health centers that receive federal funding and must serve patients regardless of ability to pay.
Dental schools also offer low-cost or free dental care performed by students under the supervision of licensed instructors. The work takes longer than it would at a private practice, but the quality is monitored closely. Search online for "dental school near me" or contact your state dental board for a list of accredited schools in your area.
Some nonprofit organizations and local health departments run dental clinics for seniors with limited income. Call your local Area Agency on Aging (find yours at eldercare.acl.gov) to ask what programs exist in your community.
What to ask your doctor or dentist
Before you have any dental work done, ask your dentist whether it might be covered by Medicare. Bring your Medicare card. If the dentist thinks the work may be medically necessary, ask them to contact Medicare for a coverage information before you proceed.
If you have a Medicare Advantage plan, call the plan directly to confirm whether the specific procedure is covered and what your out-of-pocket cost will be. Ask whether you need a referral or prior authorization.
If you are considering a standalone dental plan, ask the insurance company about waiting periods, annual maximums, and whether your dentist is in the network. Get the details in writing before you enroll.
When to seek care
Dental pain, swelling, or infection should not wait. If you have a severe toothache, facial swelling, fever, or difficulty swallowing, go to an emergency room or urgent care clinic. These symptoms can indicate a serious infection that needs when ready treatment.
If you cannot afford dental care and have a painful tooth, call your local health department or an FQHC to ask about emergency dental services. Some communities have dental clinics that see patients without an appointment for acute pain.
For routine care — cleanings, exams, and non-urgent fillings — plan ahead and budget for the cost or enroll in a dental plan during the Medicare Advantage enrollment period.
Frequently Asked Questions
Does Medicare cover dentures?
No. Medicare does not cover dentures, partial dentures, or adjustments to dentures. You will pay the full cost, which typically ranges from $300 to $2,000 per denture depending on the type and where you have it made. Some standalone dental plans cover dentures, but many have waiting periods or annual maximums that limit the benefit.
Will Medicare pay for a tooth extraction if I have an infection?
Not because of the infection alone. Medicare covers tooth extraction only if it is part of a covered medical procedure — for example, extraction before cancer surgery or as part of treatment for a serious jaw infection that requires hospitalization. Routine extraction for a cavity or gum disease is not covered. Ask your doctor whether the extraction is medically necessary as part of a covered treatment.
Can I use my Medicare Advantage dental benefit at any dentist?
Most Medicare Advantage plans require you to use dentists in their network. If you see an out-of-network dentist, you will pay more or may not be covered at all. Check your plan documents or call the plan to find dentists near you before you schedule an appointment.
What if I need emergency dental care on a weekend?
Call your local emergency room or urgent care clinic. They can treat severe pain, swelling, or infection. Some dental offices have emergency numbers for established patients. If you have a standalone dental plan, call the plan's customer service line to ask where you can get emergency care in your area.
Can I enroll in a standalone dental plan if I already have a Medicare Advantage plan with dental coverage?
Yes. You can have both a Medicare Advantage plan with dental benefits and a standalone dental plan. However, most standalone plans will not pay if another plan has already paid for the same service, so check the coordination of benefits before you enroll in both.