If you're among the 65 million Americans on Medicare, understanding dental coverage can feel confusing. You've paid into the system for years, yet dental care—something essential to your overall health—often isn't covered the way you'd expect.

According to the Centers for Disease Control and Prevention, nearly 1 in 5 adults over 65 has untreated tooth decay. Cost stands as a major barrier. The good news? While Original Medicare's dental coverage is limited, you have options to get the care you need without breaking the bank.

Does Medicare Cover Dental?

No, Original Medicare does not cover most dental care. This includes routine services like cleanings, fillings, tooth extractions, and dentures. However, coverage gets more nuanced when you look at specific situations and plan types.

Medicare Part A (Hospital Insurance)

Coverage: Very Limited

Part A covers dental services only when they're an essential part of a covered inpatient hospital stay. For example:

• Emergency or complicated dental procedures requiring hospitalization

• Dental examination before kidney transplant or heart valve replacement surgery

• Jaw reconstruction following accidental injury

Even in these situations, Medicare covers the hospital stay and the medically necessary procedure—not the dental work itself. You'd still be responsible for the dental portion.

Cost-sharing: If eligible, you'd pay the Part A deductible plus any applicable coinsurance for extended hospital stays.

Medicare Part B (Medical Insurance)

Coverage: Extremely Limited

Part B covers dental care only when it's medically necessary for another covered treatment:

• Dental exam before radiation treatment for head or neck cancer

• Dental services needed after jaw surgery to treat fractures or tumors

• Removing teeth to prepare for radiation treatment of jaw disease

These are rare circumstances. Your everyday dental needs—cleanings, X-rays, fillings, root canals, crowns, bridges, or dentures—aren't covered.

Cost-sharing: For the limited services covered, you'd pay 20% of the Medicare-approved amount after meeting your Part B deductible.

Medicare Part C (Medicare Advantage)

Coverage: Often Includes Dental Benefits

Many Medicare Advantage plans offer dental coverage as an additional benefit. According to the Kaiser Family Foundation, about 96% of Medicare Advantage enrollees had access to some dental coverage in 2024.

Coverage typically includes:

• Preventive services (cleanings, exams, X-rays)

• Basic services (fillings, extractions)

• Some plans include comprehensive services (crowns, dentures, root canals)

Important variation: Benefits differ significantly between plans. Some offer only preventive care, while others provide comprehensive coverage with annual maximums ranging from $1,000 to $3,000.

Medicare Part D (Prescription Drug Coverage)

Coverage: No

Part D doesn't cover dental services or procedures. However, if your dentist prescribes medication (like antibiotics for an infection), your Part D plan would typically cover those prescriptions.

What Does Medicare Coverage for Dental Include?

Since Original Medicare rarely covers dental care, let's focus on what medically necessary situations might qualify:

Covered hospital-related dental services:

• Dental examination required before organ transplant surgery

• Emergency dental surgery requiring hospitalization

• Jaw surgery to treat accidental injury (the surgery itself, not related dental work)

• Dental examination before radiation treatment for head or neck cancer

Medical necessity requirements:

Your doctor must demonstrate the dental service is essential for your overall medical treatment, not just beneficial for your oral health. Documentation must show:

• The dental service directly relates to a covered medical procedure

• The service is medically necessary, not cosmetic or routine

• A licensed provider has ordered the service

Example scenario: If you need radiation therapy for throat cancer, your oncologist may require a dental exam first to assess your oral health. Medicare Part B would cover this exam because it's medically necessary for your cancer treatment. However, if the dentist finds you need fillings during that exam, those fillings wouldn't be covered—they're routine dental care.

How Much Does Dental Care Cost with Medicare?

For the extremely limited services Original Medicare covers:

For routine dental care not covered by Medicare:

Without dental insurance, you'd pay full price:

• Routine cleaning and exam: $75-$200

• Filling: $150-$450 per tooth

• Root canal: $700-$1,500

• Crown: $800-$3,000

• Dentures: $600-$8,000 for full set

Medicare Advantage dental coverage costs:

Plans with dental benefits typically charge:

• Monthly premiums: $0-$100+ (many are $0 premium plans)

• Copays per service: $0-$50 for preventive care, $50-$200 for basic services

• Annual maximum: $500-$3,000 depending on plan

• Deductibles: $0-$100 (some plans have no dental deductible)

Cost example: If you need a crown that costs $1,200 and you have a Medicare Advantage plan with comprehensive dental coverage, you might pay a $100 copay while your plan covers the rest (up to your annual maximum). Without coverage, you'd pay the full $1,200.

What To Do If Medicare Doesn't Cover Your Dental Care

Since Original Medicare leaves most dental expenses to you, consider these alternatives:

Medicare Advantage plans with dental benefits:

During Medicare's Annual Enrollment Period (October 15 - December 7), you can switch from Original Medicare to a Medicare Advantage plan that includes dental coverage. This might make sense if:

• You need regular dental care beyond occasional emergencies

• You're comfortable with the plan's provider network

• The plan's other benefits meet your healthcare needs

Standalone dental insurance:

Private dental insurance plans specifically for seniors typically offer:

• Preventive care coverage (cleanings, exams) with low or no copays

• Partial coverage for basic and major services

• Annual maximums between $1,000-$2,000

• Monthly premiums ranging from $15-$50

Keep in mind that many plans have waiting periods (6-12 months) before covering major services like crowns or dentures.

Dental discount plans:

These aren't insurance but membership programs offering discounted rates:

• 10-60% savings on dental procedures

• Annual fees: $80-$200

• No waiting periods or annual maximums

• Must use participating dentists

Medicaid (for dual-eligible beneficiaries):

If you qualify for both Medicare and Medicaid based on income, your state's Medicaid program may cover comprehensive dental services. Coverage varies widely by state—some cover only emergency dental care while others include preventive and restorative services.

Community health centers and dental schools:

• Federally Qualified Health Centers (FQHCs) offer sliding-scale fees based on income

• Dental schools provide care from supervised students at 30-50% lower costs

• Some nonprofits offer free or low-cost dental days for seniors

Out-of-pocket payment options:

If paying directly:

• Ask about cash discounts (many dentists offer 5-10% off)

• Request payment plans for expensive procedures

• Consider CareCredit or other medical credit cards (watch interest rates)

• Compare prices between providers—costs vary significantly

How Aviator Health Can Help

Navigating dental coverage alongside your other Medicare benefits can feel overwhelming, especially when coverage rules differ so drastically from your medical care. An Aviator Health advocate can help you:

Compare Medicare Advantage plans during enrollment: Your advocate can review plans in your area that include dental benefits, helping you understand what's actually covered versus what sounds good in marketing materials. They'll compare copays, annual maximums, and network dentists to find a plan that matches your dental needs and budget.

Coordinate between dental and medical care: When dental issues affect your overall health—like gum disease impacting diabetes control—your advocate ensures your dentist and doctor communicate effectively. They'll help track how your oral health connects to chronic conditions.

Navigate coverage denials: If you receive dental care that you believed was medically necessary but Medicare denied coverage, your advocate can help you understand the denial, gather supporting documentation, and file an appeal if appropriate.

Find affordable alternatives: Your advocate can help you locate community dental resources, compare standalone dental insurance options, or identify dental schools and health centers in your area offering reduced-cost care.

Frequently Asked Questions

Q: Does Medicare Advantage cover dental differently than Original Medicare?

A: Yes, significantly differently. While Original Medicare covers almost no dental care, many Medicare Advantage plans include dental benefits as an extra perk. However, coverage varies enormously between plans. Some offer only preventive services like cleanings and exams (often with $0 copays), while others include basic services like fillings and extractions. Fewer plans cover major services like crowns, bridges, or dentures, and those that do usually have annual maximums between $1,000-$3,000. You'll need to review each plan's specific dental benefits, copays, and provider network before enrolling. Unlike Original Medicare where you can see any provider accepting Medicare, Medicare Advantage plans typically require you to use in-network dentists.

Q: Do I need a referral for Medicare to cover dental services?

A: For the rare situations where Original Medicare covers dental care (like a dental exam before radiation treatment), you don't need a referral, but your doctor must order the service and demonstrate medical necessity. For Medicare Advantage plans with dental benefits, referral requirements depend on your specific plan. Most don't require referrals for routine dental care, but you should check your plan documents or call member services to confirm. Some Medicare Advantage HMO plans may require referrals for specialist dental care.

Q: Will Medicare cover dental if it's medically necessary?

A: It depends on your definition of medically necessary. Medicare uses a very narrow definition: the dental service must be essential for another covered medical treatment, not just important for your health. For example, treating gum disease—even though it affects diabetes and heart health—isn't covered because it's still routine dental care. But a dental exam before radiation treatment for cancer is covered because it's a required step for covered cancer treatment. Simply put, if your regular dentist recommends it, Medicare probably won't cover it. Only when your medical doctor requires a dental service as part of treating a covered condition might Medicare step in.

Q: Does Medicare cover dental for specific conditions like diabetes or heart disease?

A: No, even though research shows strong connections between oral health and conditions like diabetes and heart disease, Medicare doesn't cover dental care for managing these conditions. The American Diabetes Association emphasizes that people with diabetes should have regular dental checkups because gum disease can make blood sugar harder to control. Despite this medical connection, Medicare still considers dental care separate from medical care. This is one of Medicare's most frustrating gaps—the system doesn't recognize that oral health is integral to overall health. You'd need separate dental coverage through a Medicare Advantage plan, standalone dental insurance, or pay out-of-pocket.

Q: Can I get dental coverage with a Medigap plan?

A: No, Medigap (Medicare Supplement Insurance) policies don't add dental coverage. Medigap plans help pay your out-of-pocket costs for services that Original Medicare already covers—like the 20% coinsurance for Part B services. Since Original Medicare doesn't cover routine dental care, there's no coinsurance for Medigap to cover. Think of Medigap as filling the gaps in Original Medicare's existing coverage, not expanding coverage to new services. If you have Medigap and want dental coverage, you'd need to purchase a separate standalone dental insurance plan or switch to a Medicare Advantage plan during the Annual Enrollment Period.

Q: How often does Medicare cover dental cleanings?

A: Original Medicare doesn't cover routine dental cleanings at all, regardless of frequency. Medicare Advantage plans with dental benefits typically cover preventive cleanings twice per year, though some plans offer only one annual cleaning. The coverage schedule varies by plan, so you'll need to check your specific plan's benefits. Most Medicare Advantage plans with dental cover preventive services like cleanings and exams at 100% with no copay when you use in-network providers, making regular preventive care affordable even though Original Medicare doesn't help.

Q: What do I need to do to ensure Medicare covers dental services?

A: For the rare situations where Original Medicare might cover dental care, follow these steps. First, get confirmation from your doctor that the dental service is medically necessary for a covered treatment—have them document this in your medical records. Second, verify that your dental provider accepts Medicare assignment. Third, ask for an Advanced Beneficiary Notice (ABN) if there's any uncertainty about coverage—this protects you by letting you know in advance that you might be responsible for the cost. Fourth, keep all documentation including your doctor's orders and any pre-authorization if required. Finally, review your Medicare Summary Notice after receiving services to confirm what Medicare paid. For Medicare Advantage dental benefits, simply use in-network providers and understand your plan's copays and annual maximums.

How to Get Dental Care Covered by Medicare

If you're in one of the rare situations where Medicare might cover dental services, here's how to ensure coverage:

Step 1: Talk to your doctor

Before any dental appointment, confirm with your physician that the dental service is medically necessary for your covered treatment. Ask them to document this medical necessity in your records and provide a written order if possible.

Step 2: Verify Medicare coverage

Call Medicare at 1-800-MEDICARE (1-800-633-4227) to confirm your specific situation qualifies for coverage. Explain your medical condition and the dental service your doctor ordered. Get the representative's name and the date you called for your records.

Step 3: Confirm your provider accepts Medicare

Ask your dental provider if they accept Medicare assignment. Even if the service is covered, you could face higher costs if your provider doesn't accept Medicare's approved amounts.

Step 4: Request an Advanced Beneficiary Notice (ABN)

If there's any uncertainty about coverage, ask your provider for an ABN before receiving services. This written notice informs you that Medicare might not cover the service and allows you to decide whether to proceed knowing you might pay out-of-pocket.

Step 5: Keep detailed records

Save all documentation including your doctor's orders, the dental treatment plan, itemized bills, and any communication with Medicare. These records become essential if you need to file an appeal.

Step 6: Review your Medicare Summary Notice

After receiving services, check your MSN (mailed every three months or available online) to verify what Medicare paid and what you owe. If Medicare denies coverage you believed would be covered, you have the right to appeal within 120 days.

For Medicare Advantage dental benefits:

• Choose a dentist in your plan's network

• Understand your copays and annual maximum before scheduling major work

• Some plans require pre-authorization for expensive procedures like crowns or dentures

• Keep track of how much of your annual maximum you've used

Takeaway

Original Medicare's dental coverage is extremely limited, covering only rare situations where dental care is medically necessary for another covered treatment. For routine dental care—cleanings, fillings, crowns, dentures—you'll need to look beyond Original Medicare.

Your out-of-pocket costs for dental care can be significant without additional coverage. A routine cleaning might cost $75-$200, while more extensive work like crowns or dentures can run into thousands of dollars.

Your options include:

• Enrolling in a Medicare Advantage plan with dental benefits during Annual Enrollment

• Purchasing standalone dental insurance

• Using dental discount plans for reduced rates

• Seeking care at community health centers or dental schools

The gap in Medicare's dental coverage is frustrating, especially since oral health directly impacts your overall health. But understanding exactly what Medicare does and doesn't cover helps you plan ahead and avoid surprise bills.

Ready to explore your coverage options?

• Contact Medicare directly: 1-800-MEDICARE (1-800-633-4227)

• Review Medicare Advantage plans during Open Enrollment (October 15 - December 7)

• Compare standalone dental insurance options in your area

• Speak with a licensed insurance agent for personalized guidance

• Consider working with an Aviator Health advocate to navigate your options

Understanding your dental coverage helps you make informed healthcare decisions and protect both your oral health and your budget. While dental coverage through Medicare isn't straightforward, knowing your options puts you in control of getting the care you need.

Disclaimer: This article provides general information about Medicare dental coverage and should not be considered medical or financial advice. Medicare coverage rules and costs change annually. Always verify current coverage details with Medicare.gov or by calling 1-800-MEDICARE. Consult with your healthcare providers and licensed insurance agents to make decisions appropriate for your individual situation.