How to Get Dental Coverage if You Have Medicare

A male patient in a dental chair with a female dentist explaining a procedure

Our dental needs change as we get older. Dental insurance helps you pay for these often-costly services.

Looking for a Medicare Plan with dental coverage? Call us today to speak to a licensed agent.

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In the movie, “Peggy Sue Got Married,” Peggy Sue faints during her class reunion, waking up in 1960. Eager to do it right this time, Peggy Sue visits her grandparents and asks them what they’d do differently, if they had the chance. Grandpa answers, “I’d have taken better care of my teeth.”

It's a funny line – and even funnier for those of us who know the simple truth in Grandpa’s words. Time does a real number on our teeth.

Unfortunately, Original Medicare doesn’t cover even routine dental exams, much less services like dentures or dental implants. Luckily, you have options to help pay for dental care.

Do you need dental insurance?

Without dental insurance, you’ll most likely be responsible for 100% of the cost of any dental care you require. Most people don’t qualify for government assistance. And for those who do, dental coverage is typically limited to extractions. This, of course, ignores the dental issues that usually affect older adults.

For example, according to the National Institute of Dental and Craniofacial Research, nearly one quarter of people over age 60 have lost all of their natural teeth, while over 40% have dental implants or wear dentures. Periodontal disease and tooth decay are the main culprits; around 23% of people aged 65 to 74 have severe periodontitis.

Another issue, particularly for seniors, is prescription medications, with over 400 of them including “dry mouth” in their list of potential side effects – another oral disease risk factor.

The earlier you buy dental insurance, the better. Don’t wait until you need coverage. Most plans have a waiting period before they pay for major dental services like crowns and bridges, or orthodontia like braces.

Dental coverage through Medicare Part C

Better known as Medicare Advantage, Medicare Part C plans are sold by private insurance companies. Every Part C plan includes the same benefits as Original Medicare, but most include additional benefits. In fact, 97% of individual Medicare Advantage plans include dental coverage.

What else can you expect from an Advantage plan? Well, 99% of them offer vision benefits – another important service not included with Original Medicare. You may also find fitness programs or gym memberships, coverage for hearing aids and exams, even over-the-counter benefits for OTC medications and supplements.

Our licensed agents can answer any questions you have about Medicare and your dental coverage options. Or, check out our Find a Plan tool. Just enter your zip code to start reviewing Medicare plans, including costs and benefits, in your area.

Standalone dental plans

If you prefer to stay with Original Medicare, or your Medicare Advantage plan does not include dental coverage, a standalone dental plan may work for you. Also known as dental, vision, hearing insurance, or DVH, the plans work much the same way medical insurance works, with monthly premiums, copays or coinsurance, and in- or out-of-network requirements.

In general, DVH insurance covers routine care. This may include:

  • Twice-yearly cleanings and exams, typically with no out-of-pocket cost
  • Extractions, likely requiring a copay or deductible
  • Fillings for cavities and tooth decay, usually with a copay or deductible
  • X-rays, with a possible copay or deductible

Usually, coverage for repairs such as bridges, crowns, and root canals does not begin until your second year. At that time, you can expect your out-of-pocket to be around 50% for major dental services and orthodontia.

Dental savings or discount plans

Please note that dental savings and dental discount plans are not dental insurance. Instead, the discount plan includes a certain group of dental providers, and you pay a fee (either monthly or yearly). When you visit one of these dentists, you show your membership card and receive a discount off the dentist’s standard rate.

Additional tips to save money on dental care

Just as with health insurance, there is great power in being an informed consumer. Take the time to perform your research, comparing plans, coverage, premiums, and providers. For example, if you have a long-standing relationship with a dentist, ask whether he or she accepts the plan you prefer.

When looking for a dentist, do not be afraid to ask for a list of fees, including charges for exams, cleanings, and x-rays. If considering one of the savings or discount plans, ask the provider what discount he or she offers. Even within the same plan, dentists offer varying discounts.

Finally, take advantage of the information provided online. A bit of time spent researching ensures you get the best plan to fit your budget.

Not sure which is the right choice for you?

If you aren't sure which choice is the better one for you, our licensed agents are ready and waiting to help. They'll help you understand the pros and cons of each option so you can make the right choice for your unique needs and budget. Call us today to get started.

Additional resources

Since 2003, Kolt Legette has helped clients navigate the often-confusing world of insurance. His number one goal is protecting the medical and financial wellbeing of every person he speaks with, whether they choose to buy insurance or not. Kolt loves representing the best brands in medical insurance as it allows him to provide side-by-side comparisons for his clients. This allows the client to decide which company works best for them. By putting the needs of the client above everything else, Kolt helps real people find affordable health insurance solutions for their most pressing healthcare needs. With his belief that peace of mind is priceless, Kolt's goal in every interaction is to make sure each person he speaks to leaves with the peace of mind they rightfully deserve

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