Medicare and Dental Coverage: What You Need to Know
When people think of Medicare, they often assume it covers all their healthcare need; including dental. Unfortunately, that’s not the case. Original Medicare (Parts A and B) does not cover most routine dental care. This can come as a surprise to new Medicare beneficiaries, and as an agent, it’s important to help clients understand Medicare and dental coverage.
What Original Medicare Covers
Original Medicare only covers dental care in very limited situations; usually when it is part of a hospital stay or a medically necessary procedure. For example:
- Jaw reconstruction after an accident.
- Tooth extractions needed before certain surgeries, such as heart valve replacement.
- Oral exams done in the hospital before a covered procedure.
Routine services like cleanings, fillings, dentures, or root canals are not covered.
Why Dental Coverage Matters
Oral health is closely tied to overall health. Poor dental health can contribute to heart disease, diabetes complications, and infections; all of which are major concerns for Medicare-aged clients. Helping your clients plan for dental costs can protect both their health and their wallets.
Options for Dental Coverage
Here are the most common ways beneficiaries can get dental coverage:
- Medicare Advantage Plans (Part C)
Many Medicare Advantage plans include dental benefits. Coverage can range from basic preventive care (cleanings, x-rays) to more comprehensive services like crowns, root canals, and dentures. Make sure to compare networks, coverage limits, and annual maximums. - Stand-Alone Dental Insurance Plans
These plans are separate from Medicare and can offer flexible options. Beneficiaries can choose plans based on coverage needs and budget. - Discount Dental Plans
Not insurance, but these plans provide negotiated discounts with participating dentists. They can be a low-cost option for those who only need occasional care. - Paying Out-of-Pocket
Some clients may choose to budget for routine care rather than purchase coverage. This may work for those with minimal dental needs, but it carries financial risk if major dental work is required.
Watch a YouTube video on Individual Dental Plan Sales
Tips for Agents
- Ask about oral health needs during your fact-finding process. This helps you recommend plans that fit your clients’ situation.
- Compare annual maximums carefully — dental coverage is often capped between $1,000–$2,000 per year.
- Educate clients about timing — enrolling in dental coverage early can help them avoid waiting periods for major services.
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Medicare beneficiaries need to know that Original Medicare will not take care of their routine dental needs. By helping them understand their options Medicare Advantage plans, stand-alone dental insurance, or discount plans; you position yourself as a trusted advisor and help them maintain both their oral and overall health.
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