While Medicare Part A and Part B (often called Original Medicare) provide coverage for a wide range of health care benefits, one of the few areas in which it comes up short is routine dental care. Dental coverage, however, is one of the additional benefits offered by some Medicare Advantage plans.
In this article, we’ll examine the ways that Original Medicare and Medicare Advantage plans treat dental care benefits so you can make an informed decision about your health care plan options.
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Original Medicare does not provide coverage for most dental care. Part A (hospital insurance) will cover certain dental services that are administered in a hospital and may provide some coverage for emergency dental care or complicated dental procedures. Routine care like cleanings, extractions and fillings, however, are not covered.
For example, Medicare may cover the cost of an oral examination that is necessary to prepare a patient for a kidney transplant. But a routine dental examination, checkup or cleaning would not be covered.
Without much help from Original Medicare, Medicare beneficiaries are essentially left with three options for paying for their dental care:
The out-of-pocket cost of dental care without any insurance can vary widely. According to the Health Policy Institute, the average per-patient dental expenditures in the United States in 2013 was $685.1
According to 2018 statistics provided by CostHelper.com, certain dental care can often come with the following costs. The costs provided are typical costs and are not intended to illustrate set or known prices for dental care where you live. The dental services listed could come with higher or lower out-of-pocket costs than those listed below.
When you add it up, simply visiting the dentist every six months for a routine dental exam and teeth cleaning could cost over $700 a year, and that’s not taking into account any necessary fillings or procedures.
Medicare beneficiaries may have the option of purchasing an individual dental insurance plan from a private insurer. Many of these plans operate on a “100-80-50” coverage agreement, in which the plan will cover 100 percent of the costs of routine dental care, 80 percent for basic procedures like fillings and root canals and 50 percent for more complicated procedures such as crowns and bridges.
Bankrate reports that the average cost of such a policy is around $350 per year.3
Another option for Medicare beneficiaries is to enroll in a Medicare Advantage plan that offers routine dental care coverage. A Medicare Advantage plan provides all the same coverage as Original Medicare (except for hospice care, which you still receive from Medicare Part A).
In addition to covering the same benefits as Original Medicare, some Medicare Advantage plans may offer additional benefits such as dental, hearing, vision and prescription drug coverage.
The dental coverage afforded by some Medicare Advantage plans can provide patients with benefits such as access to networks of qualified dentists while offering price protection in the form of deductibles, cost-sharing measures and out-of-pocket spending limits.
Plus, many Medicare Advantage plans also offer coverage for prescription drugs, so some of the medications needed for oral care may be covered under the plan as well.
In 2022, the average premium paid for a Medicare Advantage plan is around $63 per month, though many plans offer low or $0 monthly premiums.4 When you consider the annual costs of receiving dental care without insurance, you may find that a Medicare Advantage plan with dental benefits could fit your situation and health care needs.
CallTTY Users: 711 to speak with a licensed insurance agent who can help you compare Medicare Advantage plans sold in your area and outline any dental benefits they may offer.
1 Wall, Thomas. M.A., M.B.A.; Guay, Albert, D.M.D. The Per-Patient Cost of Dental Care, 2013: A Look Under the Hood. March 2016. Health Policy Institute. Retrieved from http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_4.pdf.
2 CostHelper.com. Dental Work Cost. Retrieved June 28, 2018, from http://health.costhelper.com/dentistry.html.
3 Digiacomo, Robert. Is Dental Insurance Worth the Cost? May 25, 2017. Bankrate. Retrieved from https://www.bankrate.com/finance/insurance/dental-insurance-1.aspx.
4 MedicareAdvantage.com's internal analysis of CMS Medicare Advantage landscape source files, Nov. 2021. Data retrieved from https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.