What Dental Services Does Medicare Cover? (2025 Guide)
Medicare only pays for a few dental services. Most people don’t know what is covered. This guide will help you learn what dental care Medicare will pay for and what it won’t.
Table of Contents
Quick Answer: When Medicare Pays for Dental
Medicare does not pay for most dental care. It won’t pay for cleanings, fillings, or dentures. Medicare only pays for dental work when it is part of a bigger medical need.
For example, if you need jaw surgery after a car crash, Medicare might help pay. If you need a tooth pulled before cancer treatment, Medicare might pay for that too.
Medicare Dental Coverage: The 3 Times That Qualify
Let’s look at when Medicare will pay for your dental care:
1. When You’re in the Hospital
Medicare Part A (hospital insurance) might pay for some dental services you get when you’re in the hospital. This happens when:
- You need dental work before a heart surgery to stop infection
- You had a bad accident and need jaw repair
- You need teeth pulled before cancer treatment
2. When It’s Tied to a Covered Medical Treatment
Medicare might pay when the dental work is needed for another medical treatment to work. For example:
- Oral exams before a kidney transplant or heart valve replacement
- Dental infections that must be treated before surgery
- Tooth removal to get ready for radiation in the jaw
Your doctor and dentist must work together and show why the dental care is needed for your other treatment.
3. When It’s Due to Injury or Disease
Medicare will sometimes pay for dental work needed because of an injury or disease:
- Jaw reconstruction after an accident
- Oral surgery for some face tumors
- Dental splints after jaw surgery
What Medicare Doesn’t Cover
Most dental services are not covered by Original Medicare. Here’s what Medicare won’t pay for:
- Routine cleanings and exams
- X-rays
- Fillings
- Tooth extractions (unless medically necessary)
- Root canals
- Dentures or partial dentures
- Dental implants
- Bridges
- Crowns
- Gum disease treatment
In fact, nearly half (47%) of Medicare members had no dental visits in a year, often because of cost.
The Cost Problem
When Medicare doesn’t cover dental care, people pay a lot from their own pocket:
| Fact About Costs | Amount |
|---|---|
| Average out-of-pocket dental spending | $874 per year |
| Percentage who spend over $1,000 | 19% of Medicare users |
| People who skip dental care due to cost | 1 in 5 beneficiaries |
Some groups have an even harder time getting dental care. Black and Hispanic Medicare members are less likely to see a dentist than white members.
How to Get Dental Coverage with Medicare
There are a few ways to get dental benefits if you have Medicare:
Option 1: Medicare Advantage (Part C)
Many Medicare Advantage plans include some dental coverage. Almost all MA plans offer dental coverage, but there are limits:
- Most have an annual cap (about $1,500)
- You may be limited to certain dentists in a network
- Not all plans cover major procedures like implants
Option 2: Medicaid or Dual Eligibility
If you have both Medicare and Medicaid, you might get some dental help. Each state is different:
- Some states offer comprehensive dental care
- Some only cover emergency dental services
- Some offer very limited help
Only 39% of people who qualify for both programs got dental care in 2019.
Option 3: Standalone Dental Insurance
You can buy a separate dental insurance plan. These plans usually have:
- Monthly premiums ($20-$80)
- Deductibles you must pay first
- Copays for services
- Waiting periods for some treatments
Real Examples of When Medicare Covered Dental Work
Here are true cases when Medicare did pay for dental care:
- Sara needed a tooth removed before starting chemotherapy for leukemia. Medicare Part B paid for the extraction to prevent infection during cancer treatment.
- John had a serious car accident that broke his jaw. Medicare Part A covered his hospital stay and the dental work needed to fix his jaw.
- Maria needed dental clearance before her kidney transplant surgery. Medicare covered her dental exam because infection could have caused the transplant to fail.
How to Appeal a Medicare Dental Denial
If Medicare says “no” to paying for your dental care but you think it should be covered, you can appeal:
- Ask for a “Medicare Summary Notice” (MSN) that shows the denial
- File an appeal within 120 days
- Include a letter from your doctor explaining why the dental work was medically necessary
- Send proof that the dental work was needed for a covered medical treatment
FAQs About Medicare Dental Coverage
Does Medicare cover dentures?
No. Original Medicare does not pay for dentures. You need a Medicare Advantage plan that includes denture coverage or a separate dental plan.
Can I add dental to Original Medicare?
No. You cannot add just dental coverage to Original Medicare.
You need to either:
Switch to a Medicare Advantage plan
Buy a separate dental insurance plan
What happens if I skip dental care?
Without regular dental care, small problems can become big ones. About 67,000 people go to the hospital each year for dental problems that could have been prevented. These emergency visits cost much more than regular care.
What’s Being Done to Help?
Some lawmakers are trying to add dental benefits to Medicare. The Medicare Dental Benefit Act has been proposed but hasn’t passed yet. If passed, it would help millions of older adults get the dental care they need.
Next Steps: Getting the Dental Care You Need
If you have Medicare and need dental care:
- Check if your dental need might qualify for Medicare coverage due to a medical condition
- Look into Medicare Advantage plans during enrollment periods
- Consider a standalone dental insurance plan if you need ongoing care
- Contact your State Health Insurance Assistance Program (SHIP) for free advice
- Ask about payment plans or discount programs at dental schools
- If you have low income, check if you qualify for Medicaid dental benefits
Summary
Medicare’s dental coverage has big gaps. Original Medicare only covers dental services that are part of treating another medical problem. For routine dental care, you need to find other options like Medicare Advantage or separate dental insurance.
Until Medicare changes the rules, knowing your options is the best way to keep your teeth healthy without spending too much money.
