Dental care that is primarily concerned with tooth health is not covered by Medicare and includes, but is not limited to, the following procedures:
- Routine checkups
- Cleanings
- Fillings
- Dentures (complete or partial/bridge)
- Tooth extractions (having your teeth pulled) in most cases
Unless you have private dental insurance or are using a low-cost dental resource, you will be responsible for paying the full cost of any dental care you receive. Just to be clear, Medicare will not cover or reimburse you for preventive dental care.
It’s important to remember that some Medicare Advantage Plans will pay for basic dental care like cleanings and checkups. To find out if dental care is included in your Medicare Advantage Plan, you should get in touch with your provider.
Medicare does not cover dental care that is primarily for tooth health, but it does provide limited coverage for dental care that is necessary to safeguard overall health or that is necessary for the success of another Medicare-covered health service. Medicare may pay for things like:
- Before undergoing a kidney transplant, patients are required to undergo an oral exam.
- Before undergoing a heart valve replacement, a patient may have an oral exam at a rural clinic or FQHC.
- Dental care is required before radiation therapy can be administered for some jaw diseases (like oral cancer)
- When a facial tumor is removed, the surgeon will often perform a procedure called ridge reconstruction, which involves reconstructing the ridge (or part) of the jaw that was removed
- Facial and jaw fractures can sometimes be repaired surgically.
- There will be a requirement for dental splints and wiring after jaw surgery.
However, once the underlying health condition has been treated, Medicare will no longer cover any further dental care, even if it was covered initially. Medicare may pay for a tooth extraction if it is necessary as part of surgery to repair a facial injury, as in the case of a car accident; however, Medicare will not cover any additional dental care required as a result of the tooth extraction.
Hospitalizations for dental care are covered by Medicare, too. Medicare may pay for such things as:
- If you have a serious medical condition and need to be monitored during dental work, you may be able to get it.
For these patients, Medicare will pay 100% of their hospital bills (including room and board, anesthesia, and x-rays). It won’t pay for the dentist’s services or those of other doctors like radiologists or anesthesiologists. While Medicare may pay for your hospital stay, it will never pay for any of the dental work that is not covered by Original Medicare (such as dentures).
If you need dental care but can’t afford it, research any options that may help cover the costs, such as government programs or alternative insurance plans. For an idea of what local dentists charge, you can use the consumer cost lookup tool on FAIR Health’s website.
