Many people assume Medicare includes basic dental care as part of its health benefits. In reality, Original Medicare leaves most dental services uncovered. This gap surprises seniors who need cleanings, fillings, extractions, or dentures.
Medicare Part B focuses on medically necessary outpatient services. Dental procedures rarely qualify unless they connect directly to a covered medical condition or treatment. Routine oral health maintenance falls completely outside the program.
Medicare Advantage plans often fill this void by adding dental benefits that Original Medicare excludes. These extras vary widely between plans and insurers. Knowing the rules helps beneficiaries plan expenses and explore realistic options.
Original Medicare and Dental Coverage
Medicare Part B does not cover routine dental care of any kind. This includes preventive services like cleanings, exams, X-rays, fluoride treatments, and sealants. Fillings, crowns, bridges, root canals, and gum treatments also receive no payment.
Extractions, dentures, and most oral surgeries stay uncovered unless linked to a specific medical exception. Part A covers dental work only if performed during a covered inpatient hospital stay. Even then, the dental portion must support the primary medical reason for admission.
The long-standing exclusion stems from Medicare’s original design in the 1960s. Dental care was viewed as separate from core medical benefits. Despite advocacy efforts, no broad change has occurred for routine services.
Medically Necessary Dental Services That Qualify
Part B covers certain dental procedures when they form an essential part of treating a covered medical condition. Extractions before organ transplants eliminate infection sources that could jeopardize the transplant. Similar preparatory work applies before some cardiac valve surgeries.
Radiation therapy for head and neck cancers may include covered extractions or other oral procedures. Removing diseased teeth helps prevent osteoradionecrosis, a severe bone complication. Jaw reconstruction after accidental injury or tumor removal also receives approval.
In these limited cases, the dental service must occur as an integral part of the broader medical treatment. Proper documentation and coding link the procedure to the covered condition. Coordination between medical and dental providers improves approval chances.
What Part B Does Not Cover
Routine cleanings, exams, and preventive care remain excluded regardless of age or health status. Fillings for cavities, crowns for damaged teeth, and root canals for infected pulp lack coverage. Dentures, partials, and implants receive no reimbursement.
Gum disease treatments such as scaling, root planing, or periodontal surgery stay uncovered unless tied to a qualifying medical event. Orthodontic work and cosmetic procedures fall outside benefits entirely. Even medically advised extractions for routine reasons do not qualify.
These exclusions force most seniors to pay privately or seek alternative resources. The gap affects nutrition, speech, and overall quality of life when oral health declines.
Medicare Advantage and Dental Benefits
Medicare Advantage plans frequently include dental coverage that Original Medicare omits. Many cover preventive services like cleanings and exams, often at no extra cost. Basic restorative work such as fillings and extractions appears in numerous plans.
Annual maximums typically range from $1,000 to $2,000, with some higher-end plans offering more. In-network dentists keep copays lowest, while out-of-network visits usually cost more. Waiting periods for major services may apply, though preventive care often starts immediately.
Special Needs Plans for chronic illnesses or dual-eligible members sometimes provide richer dental packages. Reviewing the Summary of Benefits during open enrollment reveals the most suitable options.
Comparison of Dental Coverage Scenarios
Here’s a clear comparison of common dental services under different Medicare paths:
| Service Type | Original Medicare (Part B) | Medicare Advantage (Typical) | Common Alternative Funding |
|---|---|---|---|
| Routine cleanings & exams | Not covered | Often $0 copay annually | Private pay / Medicaid |
| Fillings / extractions | Not covered (routine) | Usually covered with copay | Discount plans / community clinics |
| Medically necessary extraction | Covered in narrow cases | Covered (may have lower copay) | N/A |
This table shows where gaps exist and realistic alternatives.
Costs When Coverage Applies
When Part B covers a qualifying dental procedure, it pays 80% of the Medicare-approved amount after the annual deductible. The 2026 deductible is $283. You pay the remaining 20% coinsurance.
Approved amounts reflect Medicare rates, frequently lower than private dentist charges. Providers accepting assignment cannot bill beyond this limit. Hospital-based procedures may include additional facility fees.
Without coverage, a routine cleaning averages $100–$200, while extractions range from $150–$600 depending on complexity. Dentures cost $1,000–$3,000 or more. Private payment or supplemental resources become necessary in most cases.
Alternatives for Routine Dental Care
Medicaid covers dental services in many states for low-income seniors who qualify. Dual-eligible individuals often receive comprehensive oral health benefits through Medicaid. State programs differ widely in scope and eligibility.
Dental discount plans lower fees through negotiated rates at participating dentists. Annual membership costs stay low, making them practical for occasional needs. Some community health centers offer sliding-scale services based on income.
Veterans may access dental care through VA programs if they meet service-related criteria. Nonprofit organizations occasionally host free or low-cost dental clinics for seniors.
Practical Alternatives:
- Verify state Medicaid adult dental benefits online.
- Join a trusted dental discount network.
- Locate federally qualified health centers via HRSA.gov.
- Check VA eligibility if you have military service history.
These options ease financial pressure when Medicare does not help.
Preparing for Dental Visits with Medicare
Bring your Medicare card and Advantage plan ID to every appointment. Confirm whether the dentist accepts Medicare assignment or belongs to your Advantage network. Ask about payment plans if partial coverage leaves a balance.
For medically necessary procedures, carry referral notes or records showing the connection to a covered medical condition. This documentation strengthens claim approval. Discuss sedation options if anxiety or procedure complexity warrants it.
Follow post-treatment instructions carefully to promote healing. Good oral hygiene habits extend the benefits of any covered or privately paid care.
Conclusion
Medicare Part B does not cover routine dental care, including cleanings, exams, fillings, extractions, or dentures. Coverage exists only in narrow situations where the dental service supports a specific covered medical treatment. Medicare Advantage plans commonly provide broader dental benefits, making them a practical choice for oral health support. Combining plan extras with Medicaid, discount programs, community clinics, and preventive habits helps seniors maintain better dental health without overwhelming costs.
FAQ
Does Medicare Part B cover routine dental cleanings?
No, Medicare Part B does not cover routine dental cleanings, exams, or preventive services. These fall outside standard benefits. Most people pay privately or use Medicare Advantage dental extras.
When does Medicare Part B cover dental work?
Part B covers dental procedures only when they form an essential part of treating a covered medical condition. Examples include extractions before organ transplants or certain cardiac valve surgeries. Proper documentation linking the dental service to the medical treatment is required.
Does Medicare Advantage cover dental services?
Many Medicare Advantage plans include dental benefits such as cleanings, exams, fillings, and extractions. Coverage varies by plan, often with annual maximums and in-network requirements. Preventive services frequently cost $0 with participating dentists.
Are dentures covered by Medicare Part B?
No, Medicare Part B does not cover dentures, partials, or implants. Some Medicare Advantage plans offer partial coverage or allowances toward dentures. Full cost usually requires private payment or other assistance programs.
What is the cost of a dental cleaning without Medicare coverage?
A routine dental cleaning typically costs $100–$200 without coverage. Prices vary by location and office. Dental discount plans or community clinics often reduce these fees significantly.
Does Medicaid help with dental care for Medicare beneficiaries?
Yes, Medicaid covers dental services in many states for eligible low-income adults. Dual-eligible individuals frequently receive both Medicare and Medicaid oral health benefits. Coverage and eligibility differ by state.
Can I get dental coverage through Medigap?
No, Medigap policies do not cover dental services, including cleanings or procedures. They focus on filling Original Medicare gaps such as deductibles and coinsurance. Separate dental insurance or Advantage plans address oral health needs.
How do I find a dentist who accepts Medicare for covered dental work?
Use Medicare.gov to locate participating providers when exceptions apply. For Advantage plans, check the plan’s provider directory. Always verify assignment acceptance to avoid extra charges.
What if my dental claim under Medicare gets denied?
Review the denial notice to understand the reason. Gather additional medical records showing necessity. Appeal within the required timeframe with physician support. Contact 1-800-MEDICARE for assistance.
Are there low-cost dental options if Medicare does not cover?
Yes, community health centers provide sliding-scale fees based on income. Dental schools offer supervised care at reduced rates. Discount plans and local charity clinics frequently assist seniors with uncovered services.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.