What Does Medicare Not Cover: Dental Out-of-Pocket Costs
While Original Medicare — Part A and Part B — covers a variety of services and procedures, it doesn’t cover everything. The exact coverage you have will depend on your specific Medicare policy, so it’s important to check with a licensed expert to be sure you’re covered for your needs. But when it comes to dental care, you can almost always assume it won’t be covered under Original Medicare.
In fact, KFF.org found that nearly half of all Medicare beneficiaries, or about 24 million people, have no dental coverage. The same study found that average out-of-pocket spending for those who had dental care was $874 per year.
Even common procedures like cleanings, fillings and extractions and dental supplies like dentures are not covered by Original Medicare. Of course, if you’re an inpatient in a hospital, Medicare Part A may cover any necessary dental services that may have contributed to your stay.
This means you could end up paying 100% out of pocket for most of your dental care needs.
What Dental Services Are Excluded From Medicare Coverage?
Here are some common dental care services that Medicare may not cover:
Preventative care (e.g., routine oral exams, cleanings, fluoride treatments, X-rays)
Restorative services (e.g., fillings)
Endodontics (e.g., root canals)
Periodontics (e.g., scaling and root planing)
Prosthodontics (e.g., crowns, bridges, dentures, dental implants)
Are There Any Exceptions to Medicare’s Dental Coverage?
Medicare can pay for very specific dental services when they’re an integral part of a covered procedure (like jaw reconstruction following a car accident) or extractions needed before radiation treatment. It may also pay for any oral exams you may have before kidney transplants or heart valve replacements.
In these cases, Medicare Part B can cover you for outpatient services, while Medicare Part A can cover you as an inpatient.
While 47% of all people on Medicare lacked any dental coverage, those who did have coverage for dental services accessed it through:
Medicare Advantage plans
Private plans, including employer-sponsored retiree plans and individually purchased plans
If you’re unclear about your dental coverage as a Medicare beneficiary and would like some help, call Senior Healthcare Direct at 1-833-463-3262, TTY 711 to speak with a licensed agent.
For more information on common Medicare out-of-pocket costs, check out the rest of the blogs in our “What Does Medicare NOT Cover?” series:
LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.