by Russell Noga | Updated May 12th, 2023
Dental Insurance for Seniors
Around 24 million Americans don’t have any dental coverage. Losing your teeth in your golden years reduces your quality of life. It’s harder to eat, and you have an issue with needing to cover the expense of crowns or dentures.
Does Medicare Cover Dental?
If you get a toothache and need an extraction, visiting the dentist for these services can get expensive. Since most seniors live on a fixed income, they need all the help they can get to cover these additional healthcare expenses. Dipping into your retirement savings to cover these costs can ruin your financial planning.
Original Medicare covers many healthcare expenses in your golden years. However, it doesn’t cover the cost of dental cleanings and other maintenance services.
Medigap plans help to absorb the additional out-of-pocket healthcare expenses not covered completely by Original Medicare Parts A & B.
But will your Medigap plan cover dental care services?
Does Original Medicare Parts A & B Cover Dental Care Services?
No. Unfortunately, Original Medicare doesn’t cover dental care costs related to procedures like cleanings, fillings, root canals, extractions, and dentures. If you have Medicare Parts A & B, you’re responsible for covering the full cost of dental services.
However, if you’re injured in an accident and go to the hospital for jaw and dental surgery, Original Medicare might cover these expenses.
Does Medicare Advantage Cover Dental?
You can take a Medicare Advantage plan instead of Original Medicare when you turn 65. Private insurance companies sell these policies, and there are over 300 options. MA plans sometimes cover the costs of dental care services not covered by Original Medicare.
However, you might have to pay an additional premium to access these services. Or the plan might only cover part of the full costs of your care, resulting in coinsurance responsibilities. For example, Aetna Medicare Advantage offers beneficiaries three options for dental coverage.
Network – You can access preventive dental services, including X-rays and cleanings.
Direct member reimbursement allowance – You pay for the dental service charges upfront, and Aetna reimburses you when you submit a claim. There are limits on the costs covered by this plan.
Optional supplemental benefits – You purchase a supplemental dental plan for an additional monthly premium.
Medicare Advantage Dental Plans
Approximately 94% of MA beneficiaries have dental coverage in their MA plan. However, only 14% of these beneficiaries have preventative dental coverage for oral exams, cleanings, and X-rays. *6% of these beneficiaries have access to more extensive benefits, including coverage for oral surgery, root canals, fillings, and dentures.
Typically, the cost of MA plans and dental supplements varies depending on your location in the United States and age. For example, in Eastern Pennsylvania, Medicare Advantage premiums can range from $0 to $302 monthly and $0 to $397 monthly in Los Angeles.
Low-cost Medicare Advantage plans, not including extra monthly premiums for dental coverage, usually cover you for basic dental services only, such as cleanings and general checkups. The more expensive MA plans include advanced coverage of dental services like dentures and extractions but have a higher monthly premium.
Main Types of Medicare Advantage
In addition to PPOs and HMOs, other types of Medicare Part C plans include:
- HMO point-of-service (HMO-POS)
- Private fee-for-service (PFFS)
- Medical savings account (MSA)
- Special needs plan (SNP)
How Medicare Supplement Plans Work
Medigap plans help to bolster the benefits offered by Original Medicare Parts A & B. You get supplemental coverage accounting for the 20% of costs left unpaid by Original Medicare. Medigap plans come in ten options, each offering a different level of supplemental coverage.
And unlike Medicare Advantage plans, Medigap plans have no network and no prior authorization is needed for any services. If Medicare pays first, the supplement plan must pick up the difference based on the plan’s benefits. This offers great peace of mind in knowing your claims will always be paid, no questions asked.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
- Unlimited coverage for all out-of-pocket costs.
Like Original Medicare, Medigap plans don’t cover dental services in Part A & B policies. However, they may pick up some of the costs like copayments, coinsurance, and deductibles if Medicare approves the procedure.
If you’re looking for coverage for annual cleanings, extractions, dentures, etc., some providers offer discounted rates on these services if you use their in-network providers. Some Medigap insurers sell separate add-on policies that cover these services for a small monthly fee of $20 to $40, depending on your risk profile.
For example, Blue Cross Blue Shield offers its “Plan G+” policy, where you get dental services included in your coverage. The Plan G+ policy costs approximately $22 per month more than the standard plan to access these benefits (rates may vary state-to-state and by the insurer).
Enrolling in a Medicare Supplement
The Medigap “Open Enrollment” window begins on the day of your 65th birthday and lasts six months. It’s best to enroll during this time because the insurer must accept your application, even if you have a pre-existing condition, like diabetes or high blood pressure.
Applying after the Open Enrollment window closes exposes you to medical underwriting; the Insurer may decide to charge you higher-than-average premiums for your policy or deny your application. You also have “guaranteed issue rights” in some circumstances.
- If your employer’s healthcare coverage ends.
- If your service provider closes or moves out of the service area.
- If you decide to switch from Medicare Advantage to Original Medicare and Medigap in the first year of coverage.
- If you move states and your insurer doesn’t cover that area or offer your plan in that state.
Call our team, and we’ll walk you through how to apply for Medigap plans without undergoing medical underwriting.
Does Original Medicare cover dental services?
Original Medicare, which includes Part A and Part B, does not typically cover routine dental care, including checkups, cleanings, fillings, dentures, or most tooth extractions. However, some dental services may be covered if they are required as part of another Medicare-covered service, like a necessary procedure before a major surgery.
What dental services are covered under Medicare Part A?
Medicare Part A will cover certain dental services that you get when you’re in a hospital. This can include if you need to have emergency or complicated dental procedures, even though dental care isn’t covered.
Can I get dental coverage through a Medicare Advantage Plan?
Yes, many Medicare Advantage Plans, also known as Part C, offer additional benefits not covered by Original Medicare, including routine dental care. However, the specifics of what is covered can vary from plan to plan, so it’s important to check with the individual plan provider.
How can I add dental coverage to my Medicare benefits?
You can add dental coverage to your Medicare benefits by enrolling in one of the many different Dental insurance plans we offer. Coverage starts as low as $30/month, with many plans offering no waiting period for major services. Call us today to learn more at 1-888-891-0229.
Does Medicare cover dental implants?
Original Medicare does not cover dental implants.
What about coverage for dentures?
Original Medicare does not typically cover dentures. However, some of the Dental insurance plans we offer do cover them. We can help find the right plan for you.
Can I use Medicaid for dental coverage if I have Medicare?
Yes, if you qualify for Medicaid, it can supplement your Medicare coverage and may provide additional dental benefits, depending on your state’s specific Medicaid program.
How much can I expect to pay out-of-pocket for dental care with Medicare?
If your dental care is not covered by Medicare or another insurance plan, you would typically be responsible for 100% of the cost without a Dental insurance plan. The exact amount can vary widely depending on the specific dental service.
Are oral exams covered by Medicare?
Original Medicare does not cover routine oral exams as they are considered routine dental care. However, some Medicare Advantage Plans may cover routine oral exams.
Are there any dental discount programs that can be used with Medicare?
Yes, there are dental discount programs that you can use to help reduce the cost of dental care. These are not insurance, but rather programs that offer discounts on dental services at participating dentists. These can be used in addition to Medicare. Many people opt to enroll in one of our Dental insurance plans rather than a discount plan due to them having far more comprehensive coverage.
Get Help with Dental Coverage
If you’re needing Medigap or Dental insurance, call our team today at 1-888-891-0229.
We offer a free consultation to show you your options. Our licensed Medicare experts will find you the best rates in your state.
Russell Noga is the CEO of Medisupps.com, an online Medicare Agency and resource center helping Medicare beneficiaries learn about Medicare, Medigap and Part D drug plans, and Medicare Advantage plans since 2009. Russell is licensed in all 50 states and has been featured as a keynote speaker, and author of several publications, along with hosting the very popular Medisupps.com Youtube channel.