Medicare does not cover routine dental care, cleanings, or tooth extractions
Original Medicare — the federal program run by the Centers for Medicare & Medicaid Services — does not pay for dental work. This includes cleanings, fillings, crowns, root canals, dentures, and most other dental procedures. The only exception is dental care that becomes necessary because of a covered medical procedure, such as tooth extraction before radiation therapy for cancer. Even then, Medicare covers only the extraction itself, not the preparation or aftercare.
This gap affects millions of seniors. Many people discover after turning 65 that the dental insurance they had through work ends, and they must find another way to pay for dental care out of pocket or through a separate plan.
Key Takeaways
- Original Medicare does not cover cleanings, fillings, crowns, dentures, or most other dental work, even if medically necessary.
- Some Medicare Advantage plans include dental coverage, but the scope and cost vary widely by plan and by region.
- Standalone dental insurance and dental discount plans are separate from Medicare and require their own enrollment and payment.
- Medicaid covers dental care for seniors in some states, and coverage rules differ significantly from state to state.
- Community health centers and dental schools offer lower-cost care, though wait times and appointment availability vary by location.
Medicare Advantage plans may include dental coverage
Some Medicare Advantage plans (also called Part C) include dental benefits as an add-on. These are private insurance plans that replace Original Medicare and are sold by insurance companies approved by Medicare. Dental coverage under Medicare Advantage is optional for the plan to offer and varies widely.
A Medicare Advantage plan with dental might cover cleanings and X-rays at no cost, but charge you a copay for fillings or extractions. Some plans cap the annual benefit at $500 or $1,000, meaning once you reach that limit, you pay the full cost of any remaining dental work that year. Other plans have waiting periods — you may have to wait 6 to 12 months after enrolling before major work like crowns is covered.
To find out whether a Medicare Advantage plan in your area includes dental, you can review plan details on Medicare.gov or call 1-800-MEDICARE. Plans change their benefits every year, so you should check during the annual enrollment period (October 15 to December 7) if you are thinking about switching.
Standalone dental insurance and discount plans work separately from Medicare
You can buy dental insurance directly from an insurance company, independent of Medicare. These plans work like any other insurance: you pay a monthly premium, meet a deductible, and then the plan covers a percentage of the cost. Some have waiting periods of 6 to 12 months before they cover major work.
Dental discount plans are different. You pay an annual membership fee (often $80 to $200) and receive discounts at participating dentists — typically 10% to 60% off the regular price. You do not file claims; you straightforward show your membership card and pay the discounted rate at the time of service. Discount plans do not have waiting periods or deductibles, but they also do not cover emergencies or pay a portion of the bill the way insurance does.
Both types require you to enroll outside of Medicare's enrollment periods. You can buy them at any time of year, but you will pay the full cost yourself — Medicare does not subsidize them.
Medicaid may cover dental care if you may have access to
Medicaid is a joint federal and state program for people with low income. Unlike Medicare, Medicaid does cover dental care — but only in some states, and the scope of coverage differs significantly. Some states cover cleanings and basic care but not major work. Others cover more extensive treatment. A few states cover very little dental care at all.
To find out what your state covers, contact your state Medicaid office or visit your state's Medicaid website. You can also call 1-800-MEDICARE and ask to be transferred to your state Medicaid program. If you think you might may have access to for Medicaid based on income, your state Medicaid office can tell you how the process works.
Some seniors may have access to for both Medicare and Medicaid — these people are called dual may be able to access. If you are dual may be able to access, your state Medicaid program may cover dental care that Medicare does not.
Community health centers and dental schools offer lower-cost options
Federally may have access to health centers (FQHCs) are nonprofit clinics that receive federal funding and are required to serve people regardless of ability to pay. Many offer dental services on a sliding fee scale, meaning you pay based on your income. To find a health center near you, visit findahealthcenter.hrsa.gov or call 211 and ask for a referral.
Dental schools at universities also provide care at reduced cost. Students perform the work under the supervision of licensed instructors. Treatment takes longer than at a private practice — a filling might take two or three appointments instead of one — but the cost is typically 30% to 60% less. Search online for "dental school near me" or contact dental schools in your state directly.
Both options have wait times that can be weeks or months, depending on the location and how busy they are. Call ahead to ask about current wait times and whether they are taking new patients.
What to ask your doctor and dentist
If you have a Medicare Advantage plan, ask your plan representative whether dental is included and what the annual limit is. Ask whether there is a waiting period for major work and whether you need a referral to see a dentist.
If you are considering buying standalone dental insurance, ask a dentist you trust whether they accept that plan. Some dentists do not participate in certain insurance networks, and you may end up paying more out of pocket than you expected.
If you have had dental problems in the past, ask your dentist what kind of care you are likely to need in the next year. This will help you decide whether insurance, a discount plan, or a community health center makes the most sense for your situation.
When to seek care
Do not wait for a dental plan to be in place if you have tooth pain, swelling in your jaw, or difficulty chewing or swallowing. These can be signs of infection or other serious problems. Go to an urgent care center or emergency room if it is after hours, or call your doctor for a referral to a dentist who can see you quickly.
If you cannot afford emergency dental care, call 211 or your local health department and ask about emergency dental services in your area. Some communities have clinics that treat dental emergencies regardless of ability to pay.
Frequently Asked Questions
Does Medicare cover dental implants?
No. Medicare does not cover implants, the surgery to place them, or the crown that goes on top. If you have a Medicare Advantage plan with dental, check the plan documents to see whether implants are covered — most do not cover them, or cover only a small percentage of the cost.
Can I use my Medicare Advantage dental benefit at any dentist?
No. Most Medicare Advantage plans with dental have a network of dentists you must use to receive the benefit. If you see a dentist outside the network, you will pay the full cost yourself. Check your plan documents or call the plan to find dentists in your network.
What if I need a root canal and my plan has a waiting period?
If you are in pain, you may be able to have the tooth extracted without waiting, since extraction is often covered sooner than major work. Talk to your dentist and your insurance plan about your options. Some plans will waive waiting periods for emergency care.
Is there a way to get dental care without paying anything?
Some community health centers and dental schools offer care on a sliding scale based on income, which may be free or very low cost if your income is low enough. Call 211 or search findahealthcenter.hrsa.gov to find centers near you. Dental schools can be found by searching online for "dental school" in your state.
Can I switch my Medicare Advantage plan if I want better dental coverage?
Yes, during the annual enrollment period from October 15 to December 7, you can switch to a different Medicare Advantage plan or go back to Original Medicare. If you switch, any waiting periods in your new plan start over, so plan accordingly if you know you will need major dental work soon.