Original Medicare does not cover routine preventive dental services (such as exams, cleanings, or x-rays), nor minor and major restorative services (such as fillings, crowns, or dentures).
Medicare coverage is limited to dental services that are an integral part of a covered procedure, extractions done in preparation for radiation treatment for cancers involving the jaw, and oral examinations (but not treatment) preceding kidney transplants or heart valve replacements.49 Medicare also covers hospital care (such as emergency department visits) resulting from complications of a dental procedure, but does not cover the cost of the dental care itself.
Many Medicare Advantage and Medigap plans provide access to dental coverage as a supplemental, non-Medicare covered benefit. This can be a key consideration for choosing an Advantage of Supplemental plan.
Some Medicare Advantage plans charge an additional premium for dental benefits, and enrollees must pay that premium in order to receive the dental coverage. Dental premiums are in addition to premiums for other Medicare Advantage benefits, as well as the Medicare Part B premium.
Medicare Advantage plans’ cost-sharing for dental benefits varies widely from plan-to-plan and across counties. Some plans require no cost-sharing for preventive services but charge a monthly premium, while other plans require enrollees to pay a flat co-pay (e.g., $5) for each preventive service.
Similarly, for relatively extensive benefits, some plans cover most of the cost of some benefits (e.g., dentures) and others charge a flat coinsurance rate (e.g., 50%) for all services. Plans charge coinsurance rates that often range greatly – from 20-70% – and some plans require flat copayments instead of coinsurance.
We are happy to discuss dental options with our clients who are considering this coverage through Medicare Advantage or Medicare Supplemental (Medigap) enrollment.
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