If you’re new to the world of Medicare, you’ll soon discover that original Medicare (Part A and Part B) doesn’t cover most routine dental care. Nor do many Medigap plans, though some may.
Dental coverage is part of the appeal of getting a Medicare Advantage plan, known as Part C. Many Medicare Advantage plans offer dental coverage and are quick to promote that — but don’t let that alone be a deciding factor.
“Medicare Advantage plans are popular today, with over half of all Medicare beneficiaries enrolled, but benefits can vary quite a bit from one plan to another,” says Whitney Stidom, vice president of consumer enablement with eHealth, a health insurance broker and online resource provider headquartered in Santa Clara, California. “I wouldn’t recommend beneficiaries enroll in Medicare Advantage solely because they want dental benefits. However, if they find that Medicare Advantage is the best option for their overall health care needs and budget, it is a good idea to look for one that also includes dental coverage.”
Still, other Medicare recipients opt to buy a separate dental plan to cover their oral health needs.
So, if you’re looking for some sort of dental care, here’s what you need to be thinking about.
At a Glance: Medicare Coverage for Dental Care
| Medicare Plan Type | Routine Care (Cleanings, X-rays) | Comprehensive Care (Crowns, Implants) | How to Get It |
| Original Medicare (Part A and Part B) | No | No (except in specific emergency cases) | Automatic enrollment |
| Medicare Advantage | Often covered | Varies, but annual limits may cap costs | Bundled with private insurance |
| Stand-alone dental insurance | Yes | Yes, though you may have to pay coinsurance or go through a waiting period | Purchased separately |
Is Dental Coverage Worth It?
Yes, dental coverage is worth it. It doesn’t really matter if your teeth look like you were on the losing end of a boxing match, or if you flash a smile that belongs in a teeth whitening commercial — either way, it’s hard to argue that you shouldn’t have dental coverage. Poor oral health has been connected to everything from diabetes to cardiovascular disease, strokes, sinus infections, dementia and even cancer.
So if you want to keep your teeth in excellent shape, you’re going to have to find a stand-alone dental insurance plan or a Medicare Advantage plan.
[SEE: Best Toothpaste for Sensitive Teeth]
How to Assess Your Dental Needs
Before you sift through Medicare Advantage plans, you really should think about what you want out of dental insurance coverage. There are a number of criteria you may be particularly interested in:
— $0 premiums. If money is an issue, finding a plan with $0 premiums may be a top priority. However, “It’s important to look at deductibles, copays, coinsurance and annual maximums, rather than only the premium,” Stidom advises. “A lower-premium plan might cost more overall if it has high out-of-pocket expenses when you need dental care.”
— High annual benefit limits. The annual benefit limit is the most an insurance company will pay for your treatment within a year. So if you’re worried you may be in for a considerable amount of dental expenses, way beyond what an insurer will pay for an annual exam and some X-rays, you might want to prioritize this instead of, for instance, $0 premiums.
— Coinsurance. This is the portion of your insurance that you’ll pay after you meet your deductible. You’re sharing the cost of the dental work at that point, and if, for instance, your insurance is going to pay 80% of a root canal, you still are responsible for 20%. If that makes you uncomfortable, you may want to prioritize what you pay for coinsurance rather than focusing on the annual benefit limits or the size of your premium. Really, as Stidom says, you want to look at the entire picture and probably aim for a healthy balance when it comes to determining how much you should pay for dental coverage.
— Availability. Your dental coverage doesn’t do you much good if your dentist isn’t in your plan’s network. Remember to call your dentist and ask if they take the dental plan you’re considering. You may still be able to see your dentist if they’re not in-network, but you may need to pay a higher coinsurance and you may be balance billed (meaning you may need to pay the difference between what the dentist charged and what your insurance was willing to pay).
— Comprehensive or basic. Some Medicare Advantage plans only offer preventive help, paying for annual exams and X-rays. That certainly can help with your budget, and you may feel like that’s all you want covered and you’ll take care of the rest if you have cavities or other issues. However, if you do have a track record of tooth decay or believe fillings, extractions, crowns, dental implants and gum disease could be in your future, you probably will want to consider getting a plan that offers comprehensive care.
[SEE: The Best Toothache and Tooth Pain Relief Products, According to Pharmacists ]
Key Factors to Compare in a Plan
It isn’t hard to find a Medicare Advantage plan that covers oral health.
“It seems like every Medicare Advantage plan is now offering some sort of dental benefit,” says Mara Woloshin, an insurance broker, certified retirement coach and Medicare and Medicaid consultant based out of Portland, Oregon.
But it is hard to find a Medicare Advantage plan that generously pays for everything beyond cleanings and basic treatment.
“While most plans are sticking to preventative dental, some plans have capped limits and are combining comprehensive and preventative dental under one cap, like $1,000 total,” Woloshin says.
Stidom adds that “it’s important for beneficiaries to understand that dental insurance works differently than health insurance. It’s not open-ended coverage. Dental plans provide specific, defined benefits on a specific calendar-year basis, including for preventive cleanings, fillings and crowns, root canals and more. Some dental plans have waiting periods, requiring enrollees to pay their premiums for a certain number of months before services are covered.”
It’s also worth noting that if your health is poor, you may be able to find more dental coverage than you might imagine in a Medicare Advantage plan.
“The really good news for those who may have diabetes or heart disease are Medicare Advantage chronic special needs plans,” Woloshin says. “For a modest premium, like $26 monthly, this group of beneficiaries can enjoy as much as $3,500 for dental and $0 for any and all diabetic supplies.”
She adds that these plans require a diagnosis verification from an attending physician.
[READ: Does Medicare Cover Dentures?]
How to Find and Buy a Medicare Plan
If you currently have a dentist, ask the office manager what plan they would recommend. You should quickly get an earful on which Medicare Advantage plans work well in the office and which don’t, due to claims being denied.
A Medicare Advantage broker or agent, however, can also recommend a variety of Medicare Advantage plans and, if you tell them what you’re looking for, hopefully steer you to a good one.
In addition, use resources like a State Health Insurance Assistance Program (SHIP) to compare options and find the best fit. SHIP is a volunteer-staffed free helpline for seniors, their families and caregivers who need help with Medicare questions and problems.
Bottom Line
If you are getting Medicare or already have it, and you want your dental work to be paid for, you can certainly find good coverage. But in the spirit of the dentist’s office, you may have to do a lot of drilling into the details before you find one you’re satisfied with.
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What to Look for in a Good Medicare Dental Plan originally appeared on usnews.com
Update 06/03/26: This story was published at an earlier date and has been updated with new information.