What Original Medicare covers
Medicare.gov says Original Medicare doesn't cover most dental services, including cleanings, fillings, tooth extractions, dentures and dental plates. It may cover dental services in these situations:
- Some dental services during an inpatient hospital stay, when the dental procedure needs a hospital because of your medical condition or the procedure's severity.
- An oral exam and needed dental treatment before a heart valve replacement, or before a kidney, organ or bone marrow transplant.
- A procedure, such as an extraction, to treat a mouth infection before chemotherapy.
- Treatment of complications that arise during head and neck cancer treatment.
- Dental or oral exams, and treatment of mouth infections, before and during Medicare-covered dialysis for end-stage renal disease.
In these cases your usual Part A or Part B costs apply. If a dentist isn't sure Medicare will pay, ask before treatment. Because Medigap only pays toward services Original Medicare covers, it doesn't add routine dental coverage.
Medicare Advantage
Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
If dental care matters to you, look at the details in those documents: which dentists are in the network, whether there is a yearly dollar limit, how many cleanings are covered, and whether there are waiting periods for crowns, dentures or implants. In Arizona, plan choices differ a great deal from county to county. See Medicare Advantage in Arizona.
Standalone dental insurance
If you keep Original Medicare, or want more dental coverage, you can buy an individual dental policy from a private insurance company. These policies have their own premiums, yearly maximums, waiting periods and networks. The Arizona Department of Insurance and Financial Institutions (DIFI) licenses the companies and agents that sell them in Arizona. Dental discount programs are not insurance; they offer reduced fees at participating dentists.
AHCCCS dental benefits
If you have both Medicare and AHCCCS, AHCCCS covers medically necessary emergency dental care and extractions for adults 21 and older, up to a yearly limit. Members of ALTCS, Arizona's long-term care program, also have a separate yearly benefit for diagnostic, preventive and therapeutic dental care. See AHCCCS and Medicare.
Tip: Some people in southern Arizona get dental work in Mexico, for example in Los Algodones near Yuma. Medicare doesn't pay for that care, and Part D doesn't cover drugs bought there. See does Medicare work in Mexico.
Get help
A licensed insurance agent with Benefits Life can walk you through dental options with Medicare and compare plans from the companies they work with, at (602) SENIORS (602-736-4677), TTY 711. You can also see plans in your ZIP code.
Related questions
Does Medicare work in Mexico?
Medicare's rare exceptions and Medigap travel coverage.
When can I change my Medicare plan?
When you can switch to a plan that fits your needs.
Does AHCCCS pay Medicare premiums?
Help with Part B and other Medicare costs.
Sources
- Medicare.gov — Dental services
- Medicare.gov — What Medigap covers
- AHCCCS Medical Policy Manual — 310-D1, Dental services for members 21 and older
- AHCCCS — Dental services and the Arizona Long Term Care System (ALTCS)
- Arizona Department of Insurance and Financial Institutions
Frequently asked questions
Does Medigap cover dental?
No. Medigap policies pay part of the costs for services Original Medicare covers. Because Original Medicare doesn't cover routine dental care, Medigap doesn't either.
Does AHCCCS cover dental for adults with Medicare?
AHCCCS covers medically necessary emergency dental care and extractions for members 21 and older, up to a yearly limit. ALTCS members also have a yearly benefit for diagnostic, preventive and therapeutic dental care. Check with AHCCCS or your health plan for current limits.
Can I buy dental insurance separately?
Yes. Standalone dental policies are sold by private insurance companies and work alongside Original Medicare or a Medicare Advantage plan. Compare premiums, waiting periods for major work, yearly maximums and dentist networks before you buy.
