Original Medicare does not provide dental insurance for seniors. Here’s where to find it.

If you’re on Medicare, you usually have most of your general health and preventive care needs covered. But there’s at least one part of your body that may not be: your teeth.

“Original Medicare won’t cover things related to your eyes, ears or teeth, such as glasses, hearing aids or dental cleanings, fillings and dentures. What they will help cover are medical issues related to your eyes, ears and teeth, such as glaucoma, cataracts, ear imbalances and infections of the mouth,” says Bill Green, CEO of Green Insurance Agency in Orange Park, Florida, which specializes in helping seniors with their Medicare.

As a reminder, Medicare is the federal insurance program that covers people ages 65 and older (as well as some people with end-stage renal disease or certain disabilities). While it will cover things such as doctor’s visits and preventive tests (such as colon cancer screenings), it won’t cover routine cleanings, fillings, tooth extractions or dentures.

On rare occasions, Medicare may pay for dental visits or dental care, but only if it’s medically necessary. For example, you may be covered if you visit the dentist to clear up a mouth infection before surgery. But for most oral health services, it’s up to you to find coverage.

That may be one reason why so many older adults skimp on their teeth. A 2023 study in the journal Health Affairs found that restorative procedures such as fillings and crowns dropped by 8.7% after people started on Medicare. In addition, the rates of complete tooth loss went up.

But your oral health doesn’t have to suffer. If you’re in the market for a dental plan, you can explore your dental insurance options now.

For an overview of options for dental insurance for seniors on Medicare, keep reading.

Option #1: Medicare Advantage plans

Medicare Advantage plans, also known as Medicare Part C plans, offer coverage beyond what you’ll find with Original Medicare. That makes them a great option for dental and vision insurance for seniors.

But before you sign up for a Medicare Advantage plan, Green suggests that you keep the following things in mind:

• Don’t be swayed by plans that advertise money back for part B premiums. Some plans promise lower monthly bills (premiums) or money back for Medicare Part B, which covers doctor visits and other outpatient services. But the downside is that these plans usually have less dental coverage, says Green. As a result, you’ll end up paying more out of pocket for your routine dental care. And that can negate the money saved on premiums.
• Don’t pick a plan based on the dental offerings alone. Most older adults will spend more on medical health costs than they will for dental care, says Green. So, you want to make sure you have your medical care covered first. “You want to make sure your doctors and medicines are covered in network, and then tackle dental after that,” he says.

Fillings and root canals might not mean major medical bills. Learn how dental insurance can cover you.

Option #2: Stand-alone dental plans

Stand-alone dental plans cover a portion of basic dental expenses over a year. And there are a wide range of plans available, says Green.

In general, plans with higher premiums offer lower out-of-pocket costs, shorter waiting periods and a higher benefits cap. “A comprehensive plan will cost about $40 to $50 per month per person,” says Green.

Before purchasing a plan, he recommends asking yourself the following questions:

• Is your current dentist in the plan’s network? If you have a dentist you love, you’ll want to be sure you can keep seeing them.
• Is there a waiting period? Most plans cover preventive services such as cleanings and X-rays immediately, but you may have to wait a few months for services such as fillings, tooth extractions, dentures and crowns.
• How much does the plan cover? Even the most comprehensive plans won’t cover everything, says Mike Moody, D.D.S., a dentist in Portland, Oregon, and owner of Dose of Dental. Let’s say your plan says it will cover 60% of all dental costs. “If a crown costs $1,200, insurance may actually dictate that a reasonable fee is just $800,” says Dr. Moody. As a result, they’ll only pay $480 — and you’ll be responsible for the remaining $720.

Option #3: Dual Eligible Special Needs Plan (D-SNP)

While Medicare is designed for people 65 and older, Medicaid provides health coverage to people with low incomes. If you qualify for both insurance programs, you’re automatically eligible for a Dual Eligible Special Needs Plan, says Green.

Option #4: Join a dentist’s membership plan

About a quarter of dentists now offer membership plans, according to a poll of dentists from the American Dental Association. The way it works is that you make a regular monthly payment to get preventive care such as cleanings, X-rays and other procedures at a discount.

Dr. Moody says his office offers one of these plans. “We offer coverage for a year that’s around $450 and covers X-rays and dental exams, as well as discounts on services like cleanings and fillings,” he says.

There’s also a similar option called a dental savings or dental discount plan. It’s not an insurance plan, but it does require you to pay a monthly or annual fee. In exchange, you get access to discounts of 10% to 60% on dental costs.

The bottom line: You have options. If you’re interested in taking care of your teeth — which is a great idea — you can find a plan that works for you.

Big bills don’t have to get in the way of your dental health. Here’s how a supplemental dental plan can help keep costs down. Learn more online, or call a licensed insurance agent at 1-844-211-7730 for more information.

Sources:

American Dental Association. “Health Policy Institute.” Retrieved from https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy02MGM3OTJjY2IxNTYxMDAwMGY2MDZlNjEtVVJfM3BaeGhzWm12TnNMdjB4 Accessed December 6, 2023

American Dental Association. “In-office dental plans.” 2022. Retrieved from https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-insurance/in-office-dental-plans.pdf?rev=29befd8e04a94707b7caead0b46f8bee&hash=59DFBC6BA04FCB746D9A1D3CF9E32EF1

CMS.gov. “Medicare dental coverage.” November 7, 2023. Retrieved from https://www.cms.gov/medicare/coverage/dental

Health Affairs. “Dental services use: Medicare beneficiaries experience immediate and long-term reductions after enrollment.” February 2023. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01899?journalCode=hlthaff

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