About Your Teeth: Understanding Medicare Dental Coverage

About Your Teeth: Understanding Medicare Dental Coverage
  • April 25, 2024

Written By: Helena Foutz, RSSA


Some Medicare Advantage plans include dental coverage, but Original Medicare only covers dental in extreme situations, like if you’re having cancer treatment or an organ implant. You’re on your own for regular teeth cleanings, crowns, cavities, etc. I like to tell people, “Medicare only covers you from the neck down!” So what should you do?

If you already have a dentist and want to keep your dentist, find out which insurance is accepted. Do they take HMOs, like Delta or Liberty Dental? Or do they accept only PPOs? This is an important question, since there’s a major cost difference.

Another question is, do you have any deferred maintenance going on? California and many other states have a “Missing Tooth Clause,” meaning if you get insurance after you’ve already lost a tooth, the insurance won’t pay for that tooth!

Types of Dental Insurance

DHMO (Dental HMOs):

PPOs:

  • Less expensive, generally a yearly fee
  • More expensive, usually a monthly fee
  • Fixed costs, set by a dental fee schedule
  • Cost is a fixed percentage of the treatment
  • No yearly limit
  • Yearly maximum, from $500 to $10,000
  • Immediate coverage for major treatments, like crowns or dentures
  • Can have a waiting period of up to 12 months, depending on the plan
  • Less dentists take this, must be in network
  • Most dentists take it, even out of network

If you know you’d already like a PPO plan and wonder how much to get, ask the dentist. The good news is, you can get dental insurance at any time of year, it’s always open enrollment for your teeth!


Helena Foutz, RSSA is a Medicare Broker Licensed in AK, AR, AZ, CA, KS, MI, MO, NE, NV, OH, OR, TX and WA. Get in touch with Helena through her Medicare broker listing here.