Dental Coverage & Medicare- What You Need to Know

By Brian Krantz - July 21, 2022

Many of our New York Medicare clients have questions around what dental services are covered with Medicare coverage. Medicare coverage for dental services can be confusing, limited and could potentially leave you with a big expense. It’s important to know what is and what is not covered by Medicare when it comes to dental care.

Original Medicare will not cover any dental procedures that are needed for the health of your teeth including routine checkups, cleanings, fillings, implants or dentures. Even if Medicare has paid for you to get teeth extracted (if it’s needed as preparation for a medical procedure), Medicare won’t cover any of the cosmetic care after the fact.

Some Medicare Advantage plans will cover the cost of routine dental services, but not every plan will. If you have a Medicare Advantage plan, be sure to ask your provider, or one of the licensed agents at Plan Medicare if dental care is covered by your plan.

There are some instances when Original Medicare will cover dental services, but generally this is only the case if the dental work is needed to protect your general health, or if you need dental care for another health service covered by Medicare. Such instances could potentially include:

  • If you are in the hospital for a kidney transplant or a rural or federally qualified health clinic before a heart valve replacement and need to receive an oral examination.
  • If you need dental services necessary for radiation treatment of a disease that involves the jaw (such as oral cancer).
  • If you had a facial tumor removed and need reconstruction of part of your jaw as part of the procedure.
  • If you had jaw surgery and need wiring or dental splints as result.
  • If you need surgery to treat jaw fractures.

And even with these instances, Medicare will not pay for any follow up work needed. If, for example, you need to have a tooth removed before a Medicare approved surgery, and Medicare covers the cost of the extraction, it will not pay for any other dental care needed later, such as a crown or cleaning.

There are other instances when Medicare will cover the cost of procedures for dental-related hospitalizations. These include:

  • Hospitalization from a tooth infection.
  • Hospitalization during a dental procedure because of a life-threatening health condition.

And you should note that in those instances, Medicare will cover the costs of hospitalization services such as room and board, x-rays and anesthesia, but it will not cover the dentist fee for treatment or fees for other physicians. And while Medicare may cover in-patient hospital care for the afore mentioned instances, it will never cover any dental work specifically excluded from Original Medicare, even if you are in the hospital.

We now offer a variety of New York Medicare Dental Plans- speak with a licensed agent at Plan Medicare to discuss your plan options today!


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