Generally, Original Medicare does not cover dental services including cleanings, fillings, bridges, dentures, routine exams and teeth extractions. However, if you have a dental emergency that requires immediate care in a hospital, Part A of your Medicare coverage will typically pay for your care.
If you want dental coverage, you can buy a private dental insurance plan, or you can enroll in a Medicare Advantage plan that includes dental coverage.
When Does Medicare Cover Dental Services?
While Medicare does not cover routine dental services, Part A may provide some coverage in emergency situations.
Some situations in which Medicare may cover dental services are listed below.
- You need surgery to correct fractures of the jaw
- You need dental splints as a result of jaw surgery
- You need tooth extractions in preparation of radiation treatment for neoplastic diseases
- You receive a dental exam in a hospital before a heart valve replacement or kidney transplant
- You have oral cancer or another disease that affects the jaw and require dental services for treatment
Keep in mind that every situation is unique and you should speak with your doctor to find out if a specific dental service will be covered by Medicare.
Your Medicare Out-of-Pocket Costs
Even if your dental procedure is covered by Medicare, you may still have to pay some money out of pocket. Some of your Medicare out-of-pocket costs in 2018 can include:
Medicare Part A deductible
- $1,340 per benefit period. This is the amount you have to pay in a benefit period before your Medicare Part A benefits kick in and begin paying for your hospital costs.
Medicare Part B deductible
- $183 per year. You have to pay this amount within the year before Medicare Part B pays for services it covers.
Medicare Part A coinsurance
- $0 coinsurance per day for days 1-60 of an inpatient hospital stay
- $335 coinsurance per day for days 61-90
- $670 coinsurance per each lifetime reserve day after day 90 of your hospital stay (you have up to 60 reserve days over your lifetime)
- All costs beyond your lifetime reserve days are all used
Medicare Part B coinsurance
- 20 percent of the Medicare-approved amount for most health services and medical devices
If you have Original Medicare, you may consider purchasing Medicare Supplement Insurance, which can help cover some of these out-of-pocket costs.
Medicare Supplement Insurance
Medicare Supplement Insurance (also known as Medigap) helps cover some of the out-of-pocket costs of Original Medicare.
Medicare Supplement Insurance plans do not cover dental services. However, if you suffer a dental emergency and must visit the hospital, a Medicare Supplement Insurance plan may cover your Medicare Part A deductible and copayment, as well as your Medicare Part B deductible. The out-of-pocket Medicare costs your Medigap plan would cover depends on which type of plan you buy. Additionally, some Medicare Supplement Insurance plans cover foreign travel emergency care, meaning you can have certain services covered if you experience an emergency outside of the U.S.
There are 10 standardized Medigap plan types in most states, each offering a unique combination of basic benefits. All 10 standardized Medigap plans cover your Medicare Part A coinsurance and hospital costs.
Although a Medicare Supplement Insurance plan will not cover routine dental services, it could save you significant money if you have a dental emergency. If you make frequent visits to the dentist, you may also consider enrolling in dental insurance policy through a private insurer. Dental hygiene becomes even more important as you age and poor oral health can increase the risk for things like diabetes and heart disease, so it's critical for all aging adults to maintain regular dental checkups.
To learn more, connect with a licensed agent at 888-264-0148 or read through our guide on Medicare Supplement Insurance.