Medicare Doesn’t Cover That (Dental)

In every Medicare consultation we have with a Medicare beneficiary, dental coverage pops up.  Good dental care and hygiene is an indicator of your overall health, so it’s understandable that most people want dental coverage while on Medicare.

Unfortunately, Original Medicare doesn’t cover most dental services.  Not the usual dental care you are used to, such as cleanings, fillings, crowns, x-rays, implants, etc.  Medicare Part A (hospital) does pay for certain dental services when you’re in a hospital, but that would only be in very limited situations.  Think: mouth and jaw reconstruction after an accident.

So how should you address this?

Cash Pay

Some Medicare beneficiaries go this route by paying cash, which typically comes at a discounted rate for dental services.  Many dental offices provide a discount of at least 10% for not having to run the claim through an insurance carrier. Check with your dentist’s office to see if they offer cash discounts or potentially their own dental coverage program.

Stand-Alone Dental Insurance Plan

You can always purchase a dental insurance plan at any time while on Medicare.  There are many dental insurance plans available, but you’ll want to confirm that your dentist is in-network with any plans you’re considering. Talk with your dentist first to narrow down your search.  For more support, you can work with an independent insurance agent like Medicare Mindset. We can help you find which plans have your dentist in-network.

If your dentist doesn’t accept any insurance, there are few dental plans that work well in these situations.  Basically, the plans will allow you to submit the claims for any dentist you want to see, which will then be reimbursed for allowed services up to a maximum limit each year.

Keep in mind:  It’s pretty common to see waiting periods for certain dental services when you initially purchase a stand-alone dental insurance plan.  For instance, a 6- or 12-month waiting period could be required for major services like crowns and extractions.

Dental Insurance Plan Inside a Medicare Advantage Plan

Medicare Advantage plans, which can combine Medicare Parts A, B, and D into one plan, do have the ability to provide extra benefits for dental services that Original Medicare doesn’t cover.  Always confirm this in the plan’s Summary of Benefits document.  

You’ll see these plans in two variations:

Built-in dental plan with no additional premium

You might receive one or two no-cost teeth cleanings per year, a set of x-rays, or a fluoride treatment.  There won’t typically be an additional premium for this option, but the coverage is lacking for any major dental services.

Optional supplemental benefit dental plan with a premium

If you prefer a more comprehensive dental insurance plan, some Medicare Advantage plans will include Optional Supplemental Benefits at an additional premium each month.  This could help beef up your dental coverage to a higher level…and sometimes include no waiting periods! Again, verify the offerings in the plan’s Summary of Benefits document.  

In both variations, the plan could use a specific dental network of providers, so be sure to check your dentist’s participation in the network.  

You don’t have to navigate dental care alone.  Please contact us with your dental insurance questions.  We can guide you in the right direction.

Reference Links

Medicare Dental Services

Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.