When it comes to Medicare, it can be confusing to know what’s covered and what’s not under each part. While Original Medicare provides basic coverage, it lacks in providing coverage for much-needed services like dental care. This can catch many new beneficiaries off guard. For those concerned about dental coverage, you may be wondering what options you have when it comes to Medicare. Let’s take a look at what Medicare covers when it comes to dental care and how you can get the coverage you need.
Original Medicare and Dental Coverage
Original Medicare consists of two parts, Part A (hospital insurance) and Part B (medical insurance). In general, neither parts cover routine dental care. One expectation in which you may be covered for dental services under Original Medicare is if you suffered a traumatic injury to the jaw, teeth, or mouth that required hospitalization. In this instance, you may be covered under Part A for any reconstructive surgery and for your hospital stay. For all other dental services like routine cleaning, extractions, fillings, etc. you will have to pay out of pocket.
Does Medicare Part D cover Dental?
Medicare Part D is the part of Medicare that provides prescription drug coverage. Part D plans are offered as stand-alone plans that work in addition to your Original Medicare coverage. Since Part D plans only offer prescription drug coverage, they do not cover dental care. However, if you are hospitalized due to a traumatic injury to the mouth, Part D will cover any prescription medications necessary after hospitalization. For all other dental services, you will have to pay out of pocket.
Medicare Advantage and Dental Coverage
Paying out of pocket for dental care can be very costly especially for those living on a limited income. In fact, according to the National Poll on Healthy Aging, “about half of adults age 65–80 (47%) reported that they do not have dental insurance.” Luckily there is a solution with a Medicare Advantage plan.
Medicare Advantage, also known as Part C, provides all the same benefits as Original Medicare plus more. Private insurance carriers offer plans that are approved by Medicare. Often these plans include additional benefits like:
- Prescription drug coverage
- Other health perks
For more information regarding Medicare Advantage plans see, “What do Medicare Advantage Plans Cover?”
For dental coverage, Medicare Advantage provides most routine services including:
- Routine cleanings
- Oral exams
- Dental X-rays
- Diagnostic services
- Restorative services including fillings
- Root canals
- Treatment for gum disease and oral inflammation
It is important to note that not all Medicare Advantage plans cover dental care so it is important to review coverage details before enrolling.
Medicare Advantage Enrollment Period
If you’re considering enrolling in dental care coverage through a Medicare Advantage plan, it is important to be aware of enrollment opportunities. Medicare Advantage is available to enroll in during the following times periods:
✅ Initial Enrollment Period (IEP)
The initial enrollment period is your first opportunity to enroll in a Medicare Advantage plan. This enrollment period runs for 7 months which includes:
- 3 months before your 65th birthday
- Your birth month
- 3 months after your 65th birthday
✅ Annual Enrollment Period (AEP)
The Annual Enrollment Period runs each year from October 15 – December 7. During AEP, you can enroll in a Medicare Advantage plan for the first time, switch from one Medicare Advantage plan to another, or switch from Original Medicare to a Medicare Advantage plan.