Nearly 2 out of 3 seniors on Medicare lack dental coverage, according to a recent report from the Kaiser Family Foundation. This gap in benefits can leave older adults vulnerable to serious health and financial consequences. If you’re one of the 37 million Americans over 65, understanding your options for dental care under Medicare is crucial for protecting your smile and your savings.
What dental services does Original Medicare cover?
Original Medicare (Parts A and B) generally does not cover routine dental services like cleanings, fillings, extractions or dentures. Medicare dental coverage is very limited, and is typically only provided in emergency situations related to other covered medical procedures.
For example, Medicare Part A (hospital insurance) may pay for certain dental services you get while in the hospital, such as:
- A dental exam before a kidney transplant or heart valve replacement
- Jaw reconstruction after an accident
- Tooth extractions necessary for radiation treatment of cancer
But, Medicare will not cover the cost of any routine dental care needed before or after these procedures, like fillings or crowns.
According to the American Dental Association, almost half of all Medicare beneficiaries (47%) have no dental insurance, and face steep out-of-pocket costs for essential dental treatments. A quarter of seniors have not seen a dentist in the past five years, and 19% currently have untreated cavities.
Can Medicare Advantage plans provide dental coverage?
Some Medicare Advantage plans (Part C) do offer dental benefits as part of their bundled coverage. These plans, sold by private insurers, include Parts A and B benefits and often additional services like dental, vision, and prescription drugs.
However, not all Medicare Advantage plans cover dental, and those that do vary widely in their costs and scope of coverage. Some key differences include:
- Benefit limits: Common annual maximums range from $500 to $2,000
- Covered services: Some plans only cover basic cleanings and x-rays, while others include fillings, crowns, root canals, and dentures
- Coinsurance and copays: Most plans require cost-sharing of 20-50% for non-preventive services
- Network restrictions: Many plans require you to use dentists in their network or pay more out-of-pocket
Before enrolling in a Medicare Advantage plan for dental coverage, carefully review the plan’s summary of benefits and provider network. You can compare available plans in your area using the Medicare Plan Finder.
As of 2024, 94% of individual Medicare Advantage plans provide some dental coverage, but only 86% cover both preventive and more extensive dental benefits. The average Medicare Advantage enrollee pays $xx per month extra in premiums for dental benefits.
What other dental insurance options exist for seniors on Medicare?
If you don’t have dental coverage through Medicare, there are a few other ways to access more affordable dental care:
- Standalone dental insurance plans
- Offered by many major health insurers like Delta Dental, Aetna, and Cigna
- Costs range from $20 to $50+/month depending on the level of coverage
- Most cover 100% of preventive services and 50-80% of treatments after a deductible
- May have waiting periods of 6-12 months for major procedures
- Example: [[Insurance Provider]] Silver Plan: $35/mo, $50 deductible, covers cleanings and x-rays at 100%, fillings at 80%, and crowns, root canals and dentures at 50%
- Dental savings plans (also called dental discount plans)
- Provided by companies like DentalPlans.com and Careington
- Members pay an annual fee ($100-200) to get 10-60% off most dental services
- No annual caps, deductibles or waiting periods, but no coverage for costly procedures
- Best for those who need mostly preventive care and small fillings
- Example: DentalPlans.com Care 500 Plan: $100/yr, get 20-50% off preventive care, fillings, crowns, and root canals at 100,000 dentists nationwide
- Medicaid dental coverage
- Some state Medicaid programs provide dental benefits for low-income seniors
- Eligibility and coverage vary widely by state (see Medicaid Adult Dental Benefits)
- Usually covers emergency dental treatments and may include preventive services
- Example: California Medicaid (Medi-Cal) covers exams, cleanings, fillings, crowns, root canals, dentures and more with $1 copays and no annual limit
- Low-cost dental clinics and dental schools
- Some community health centers, faith-based clinics and dental hygiene schools offer free or discounted care to seniors
- Services are often provided by students supervised by licensed dentists
- May have income/age requirements and limited services and availability
- Example: The Rutgers School of Dental Medicine in Newark, NJ offers a heavily discounted general dentistry program for seniors as well as a specialty program for veterans
Why your dental health matters, especially as you age
Neglecting your oral health due to cost concerns today can lead to larger medical bills and poorer quality of life down the road. Over half of seniors have severe gum disease, which is linked to a higher risk of heart disease, stroke, diabetes, and Alzheimer’s.
Dental problems also impact seniors’ nutrition, mental health, and social well-being. A quarter of older adults avoid smiling due to the condition of their teeth, and those with severe tooth loss are less likely to eat a balanced diet. Oral pain and infections are a top reason for ER visits among seniors.
While Medicare doesn’t make it easy, preventing and treating dental disease is a crucial investment in your overall health as you age. Take these steps to protect your pearly whites without breaking the bank:
- Prioritize a dental plan that covers two annual cleanings and sets of x-rays to catch problems early
- Brush twice daily with fluoride toothpaste and floss at least once a day
- If you need extensive dental work, get a pre-treatment estimate and consider spacing out procedures
- Ask your dentist about lower-cost alternatives (i.e. silver vs. composite fillings)
- See if you qualify for free/discounted care at dental schools or community clinics
- Use a dental savings plan for preventive visits and an individual plan for costlier needs
You can also advocate for expanded dental benefits under Medicare by contacting your representatives in Congress. Multiple bills have been introduced to add a dental coverage option to Medicare Part B, but have yet to pass due to funding disagreements.
The bottom line
If you rely on Original Medicare for your health coverage, don’t assume your dental needs are taken care of. While some Medicare Advantage plans offer dental benefits, coverage is often limited and comes with additional premiums and restrictions.
Review your current coverage and dental health needs to determine if a standalone dental plan, discount plan, community clinic or combination of options works best for your budget and smile. The most important thing is to continue regular dental visits and treatment – skipping care now will only lead to more painful and expensive problems later.
Navigating Medicare dental coverage isn’t easy, but your oral health is worth investing in. Share this article with others struggling with this issue and comment with your own experiences and advice. By advocating for yourselves and each other, we can push for a healthcare system that values the dental needs of seniors.
