Medicare and dental care

Medicare does not cover dental services that you need primarily for the health of your teeth, including but not limited to:

• Routine checkups
• Cleanings
• Fillings
• Dentures (complete or partial/bridge)
• Tooth extractions (having your teeth pulled) in most cases

If you receive dental services, you will be responsible for the full cost of your care unless you have private dental coverage or are utilizing a low-cost dental resource. Again, Medicare will not pay for or reimburse you for dental services you receive primarily for the health of your teeth.

Note: Some Medicare Advantage Plans cover routine dental services, such as checkups or cleanings, as supplemental or extra benefits. If you have a Medicare Advantage Plan, contact your plan to learn about dental services that may be covered.

Limited Medicare coverage

While Medicare does not pay for dental care needed primarily for the health of your teeth, it does offer limited coverage for dental care needed to protect your general health, or for dental care needed in order for another Medicare-covered health service to be successful. For instance, Medicare may cover:

• An oral examination in the hospital before a kidney transplant
• A dental or oral exam and treatment before a heart valve replacement
• Reconstruction of part of the jaw when a facial tumor is removed
• Surgery to treat fractures of the jaw or face
• Dental splints and wiring needed after jaw surgery
• If you have End-Stage Renal Disease (ESRD)
  • An oral exam and dental treatment before or while receiving dialysis
  • Removal of dental infections before or while receiving dialysis
• If you have head or neck cancer:
  • A dental or oral exam and treatment needed before or during Medicare-covered care for head or neck cancer
  • Treatment for dental complications you have after getting care for head or neck cancer

It is important to know that while Medicare may cover initial dental services in these situations, follow-up dental care after the underlying health condition has been treated is not covered. For example, if you were in a car accident and needed a tooth extraction as part of surgery to repair a facial injury, Medicare may cover your tooth extraction—but it will not pay for any other dental care you may need later because you had the tooth removed.

Medicare also covers some dental-related hospitalizations. For example, Medicare may cover:

• Observation you require during a dental procedure because you have a health-threatening condition

In these cases, Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists. Further, while Medicare may cover inpatient inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). hospital care in these cases, it never covers dental services specifically excluded from Original Medicare (like dentures), even if you are in the hospital.

If you need dental care, look into resources or other forms of insurance that may help pay for dental services. You can also use FAIR Health’s consumer cost lookup tool to get an estimate for the amounts dental professionals usually charge in your area for different services.