Dental care is excluded from Medicare coverage. 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. If you have a Medicare Advantage Plan, contact your plan to learn about dental services that may be covered.
While Medicare does not pay for dental care needed primarily for the health of your teeth, it does offer very 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
- An oral examination in a rural clinic or Federally Qualified Health Center (FQHC) before a heart valve replacement
- Dental services needed for radiation treatment for certain jaw-related diseases (like oral cancer)
- Ridge reconstruction (reconstruction of part of the jaw) performed when a facial tumor is removed
- Surgery to treat fractures of the jaw or face
- Dental splints and wiring needed after jaw surgery
It is important to know that while Medicare may cover these initial dental services, Medicare will not pay for any follow-up dental care after the underlying health condition has been treated. 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 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.