5 Things You Should Know About Dental Coverage and Medicare

Most mouth problems aren’t covered, but you have other options

Kimberly Lankford,

AARP

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En español

Published April 19, 2023

patient checking her teeth into a hand mirror after her dental treatment. Senior patient checking her teeth after treatment at dentist

Luis Alvarez / Getty Images

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.

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.

1. 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.

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.

Find out more about Medicare Advantage plans in your area by typing your zip code into the Medicare Plan Finder. You’ll see a green check mark ✓ beside Dental if a plan includes dental coverage. Click Plan Details | Extra Benefits to see summaries of preventive and comprehensive dental coverage.

“If dental care is important to you, you need to look at the plan’s summary of benefits or evidence of coverage to see what the plan will cover as part of its dental package,” Freed says. Usually, this information is on a plan’s website.

Since you can switch Medicare Advantage plans every year during open enrollment from Oct. 15 to Dec. 7 with coverage starting Jan. 1, check the fine print on your policy if you expect to have extensive dental work during the next calendar year. Consider that, too, when choosing a Medicare Advantage plan, along with coverage for your doctors, prescription drugs and health care needs. Some plans have dental provider networks, so make sure your dentist is included.

2. Stand-alone dental policies aren’t all alike

Even though Medicare Advantage is the most common way for Medicare beneficiaries to get dental coverage after retirement, you have other options.

“Cost, benefit coverage, deductibles, waiting periods and annual maximums vary across the different types of dental plans by insurance carrier or provider and by state,” says André Richards, spokesman for Delta Dental. The largest U.S. dental insurer for all ages sells individual and group dental plans, including an AARP-branded plan.

Premiums for stand-alone dental policies vary based on coverage level and location. Policies generally don’t have preexisting condition exclusions but may require a waiting period before covering some expensive procedures, says Gregg Ratkovic, chief business officer for insurance broker eHealth. They can also have an annual coverage cap.

Stand-alone dental policies for people 65 and older generally cost $20 to $50 a month, Ratkovic says. These plans typically cover checkups and cleanings, but you’ll often pay 20 percent to 50 percent plus an annual deductible of $50 to $100 for work to restore teeth. Some plans won’t cover replacing a previously covered missing tooth. You should check to see if your dentist is in network.

3. Other options for dental coverage

You may be eligible for dental coverage from other sources:

Dental discount programs. These programs typically charge an up-front annual fee and provide discounts such as 30 percent to 40 percent off cleanings, crowns, exams and fillings. You may be required to use certain dentists.

Employer or retiree dental coverage. Half the people 65 or older who had dental insurance had coverage through an employer or retiree plan, according to the National Poll on Healthy Aging.

Medicaid. The joint federal-state program provides dental coverage in some states for people who meet income and asset requirements. About 1 in 9 Medicare beneficiaries had dental coverage through Medicaid in 2019, according to the KFF study. Fewer than half the states provide care beyond emergency dental services for adults. Contact your state Medicaid office for details.

Medigap add-ons. Medigap policies, which help cover original Medicare’s out-of-pocket costs, don’t include dental coverage in their standardized benefits, but some plans let you add on dental coverage for an additional premium. In 2020, about 1 in 8 Medicare beneficiaries were enrolled in Medigap plans with additional dental, hearing or vision benefits, according to the Commonwealth Fund.

Veterans benefits. The U.S. Department of Veterans Affairs provides dental care benefits to veterans who qualify based on their service-connected disability rating and other factors.

4. Your dentist can help you plan

Before you retire, talk with your dentist about care that’s important to have in the next few years, says Leonard Brennan, a retired dentist and codirector of the Harvard School of Dental Medicine’s Geriatric Fellowship Program. If you need some expensive services, consider scheduling them while you still have dental coverage from your employer. It could be better than your future coverage.

Ask your dentist about other ways to save money. If you’re nearing your policy’s annual coverage cap, the dentist may be able to spread out some services into the next calendar year. Some dentists offer in-house dental membership programs or discounts for up-front payments.

To give you an idea about how much different procedures cost in your area, Delta Dental has a cost estimator.

5. Tax-free HSA money can help with dental costs

If you had a high-deductible health insurance policy and made contributions to a health savings account (HSA), you can withdraw money tax free for eligible medical expenses, including out-of-pocket dental costs.

You can’t make new contributions to an HSA after you enroll in Medicare, but you can withdraw money tax free for eligible expenses at any age. If you haven’t enrolled in Medicare yet, setting aside money in an HSA is a good way to prepare for these costs.

Video: What Doesn't Medicare Cover?

This story, originally published April 22, 2022, has been updated with new charts and statistics.

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Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.