5 Things You Should Know About Dental Coverage and Medicare; Most mouth problems aren’t covered, but you have other options.
01/13/2024

If you're just finding out that original Medicare doesn't cover routine dental care or procedures, you're not alone. Many people don't realize this until they retire.

 

 

Medicare limits dental coverage to specific medically related circumstances, so yearly exams, extractions, root canals and routine cleanings aren't part of the plan. Medical-related coverage may include surgery to treat jaw fractures, limited dental services in preparation for radiation treatment of oral cancer, or an oral exam in a hospital before a kidney transplant.

In 2023, Medicare expanded its coverage to add dental exams and necessary treatments required before organ transplant surgery — not just kidney transplants — and cardiac valve replacement. Beginning in 2024, Medicare will cover a dental exam as part of a comprehensive workup at the same time as Medicare-covered treatments for head and neck cancer.

 

 

Despite those changes, Medicare still doesn't cover most dental care. If you want coverage, you'll need to find it somewhere else. The percentage of people with dental coverage drops dramatically at age 65 after they retire and lose dental insurance from their employers.

 

Beyond preventive services, members usually have to pay a larger portion of the cost for crowns, dentures, extractions, implants, root canals and treatments for gum disease. The most common coinsurance amount that KFF found was 50 percent for more extensive services. Cost sharing ranged from 20 percent to 70 percent in the plans studied.

 

Coverage caps averaged $1,300 in 2021 but varied significantly. You may find higher limits if you shop around, but expect to pay higher premiums than for plans with lower limits, Freed says.

 

 

Dental coverage drops after retirement

 

 

Among adults ages 50 to 64, a little more than a quarter lack dental insurance, according to the University of Michigan National Poll on Healthy Aging, which AARP sponsors in part. But among people ages 65 to 80 — who generally are covered by Medicare — 47 percent of those surveyed were without coverage.

 

One in 5 older adults polled said they had delayed getting dental care or gone without it in the past two years. The majority said cost or lack of coverage played a role in that decision.

 

"Older adults have complex oral health needs. And either they don't get the care they need, or they face high out-of-pocket costs trying to get the care they need," says senior policy analyst Meredith Freed with KFF's program on Medicare policy. KFF used to be known as the Kaiser Family Foundation.

 

A private Medicare Advantage plan or stand-alone dental policy may cover some dental needs, but details vary. Some plans will pay only half the cost for extractions, fillings, root canals and major procedures.

 

The good news is you have options and ways to help you cover the costs.

 

Medicare Advantage coverage varies

 

Almost all Medicare Advantage plans provide some dental coverage. Only 10 percent of Medicare Advantage enrollees are required to pay a separate premium for dental benefits, according to KFF.

 

"Most plans cover preventive services, such as cleanings and X-rays, but the coverage of more extensive services definitely varies," Freed says. The KFF study found nearly two-thirds of enrollees in plans with access to cleanings, oral exams and X-rays don't have to pay for these services.