Dental Coverage Under Medicare
Medicare covers almost no dental services. Not exams. Not cleaning. Not dentures. Not drilling. Not filling. Zip. Zero. Nada. The exceedingly rare situations in which Medicare covers dental services are those in which dental services are an integral part of care for a non-dental problem, such as a jaw injury or bone cancer.
That being said, the only way that you will obtain dental services under Medicare is to enroll in a Medicare Advance Plan that offers dental services as an extra benefit or enroll in a dental plan for seniors on Medicare. With Medicare Advantage Plans, precisely because they are an extra benefit, they tend to be limited, but some coverage is certainly better than none. Coverage in separate dental plans may be more generous.
Because both Medicare Advantage Plans and dental plans for seniors on Medicare are both private businesses not affiliated with the federal government, you must deal with a Medicare agent in order to get them. The Social Security office or Medicare can only refer you to an agent if you have questions about these plans.
When Can I Enroll?
For Medicare Advantage Plans that offer dental services as an extra benefit, your Original Enrollment period starts the third month before your 65th birthday and runs for seven months. There is also an open enrollment period from January 1 to March 31 of each year. You also have a special enrollment period if you lose coverage because your plan shut down, or stopped offering services in your area, you lost employer-provided insurance that you were using as evidence of creditable coverage, you were given wrong information about enrollment by a Federal employee, and a few other situations.
Open enrollment for stand-alone dental plans for seniors is usually year-round, but this may vary in some states and localities. Again, your Medicare insurance agent is your best source here; Medicare cannot help you.
How Much Does It Cost?
As with American health care in general, prices vary widely and wildly. Premiums for Medicare Advantage Plans with dental services range from $0 per month to around $100 per month; premiums for stand-alone dental plans range from $0 to $100 per month. That being said, why, you may ask, does not everyone pick the zero-premium plans? The answer is coverage. You get what you pay for, and higher-cost plans generally, but not always, offer lower deductibles and copayments and a wider range of services.
About half of adults on Medicare do not have dental coverage. It is not advisable to be one of them.