There is very little coverage for Dental Under Medicare
Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. In rare cases, Medicare Part B Doctor Visits will pay for certain dental services. In addition, Medicare Part A Hospital will pay for certain dental services that you get when you are in the hospital. medicare.gov/dental
Some Medicare Advantage plans may include dental benefits. See the Quote boxes on the right or scroll down to get a separate dental policy.
We did not in our research find any coverage under Medicare for Accidents!
Medicare will pay when
- you receive an oral examination in the hospital because you will be having a kidney transplant or in a rural or federally qualified health clinic before a heart valve replacement;
- you have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
- you had a facial tumor removed and had ridge reconstruction (reconstruction of part of the jaw) as part of that procedure;
- you need surgery to treat fractures of the jaw or face; See TMJ below
- you need dental splints and wiring as a result of jaw surgery.
While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated. For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.
Medicare will pay for some dental-related hospitalizations, for example, if
- you develop an infection after having a tooth pulled;
- you require observation during a dental procedure because you have a health-threatening condition.
Note: Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.
While Medicare may pay for in-patient hospital care in these circumstances, Medicare will never cover any dental care specifically excluded from Original Medicare (i.e., dentures), even if you are in the hospital.
Learn more ⇒
Justice in Aging – Oral Health for older Americans
Medical Loss Ratio – Insurance Companies must pay out 80% of what they take in in premiums. If they are going to pay for Dental Implants, how much do they have to charge?
Exclusions
Coverage Determinations cms.gov –
Dental Exam prior to Kidney Transplant 260.6
Dental For Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
One of our colleagues on how Dental for Everyone Works
Sample Quote
Blue Cross Dental & Vision
Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental
Blue Shield Medicare Advantage Dental & Vision
See also our pages on dental for under 65
Dental & Vision for Adults and Mandatory Pediatic as an essential benefit
TMJ, which may be related to trauma
(such as a blow to the face),
may be covered
Treatment efforts are directed toward:
1) reduction of pain,
2) improvement of dysfunction,
3) slowing the progression of the joint disease.
Temporomandibular joint arthroplasty is usually attempted after all nonsurgical methods of treatment have failed (AAOMS, 2001).
Conservative therapy is the mainstay in treating TMJ. This therapy may include behavior change, oral medications for pain, anti-inflammatory injections, and orthotic devices. Surgical treatments, often irreversible, may be recommended for difficult or unresponsive cases.
Learn more ⇒ anthem.com
Dental For Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
One of our colleagues on how Dental for Everyone Works
Sample Quote
Blue Cross Dental & Vision
Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental
Blue Shield Medicare Advantage Dental & Vision
There is NO Pre existing condition clause in Medicare or Medicare Advantage Plans
Federal Law on Medicare – Part A law.cornell.edu/
Part B aw.cornell.edu
(D)in the case of inpatient hospital services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services; law.cornell.edu/
Introduction to all our websites
by Steve Shorr
Our Biography Webpage
Introduction to Medi Gap and Medicare Advantage Video
Oral Health for Seniors
Justice in Aging - Advocates Guide
- Justice in Aging - Webinar Oral Health Coverage for Low Income Seniors
- Denti-Cal
- 4 page summary of Denti Cal benefits from Justice in Aging
- National Institute for Dental Research - Caregiver information
- Health.Gov tips for older adults
- nia.nih.gov/taking-care-your-teeth-and-mouth
Sample Quotes
Sample Quote – Click here for YOURS
Careington Discount Dental Plan
Participant$6.95/mo
Plus One$11.95/mo
Family$18.95/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- This is a Discount Plan.
- Plan Maximum:
- ** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
| Waiting | You Pay | |
|---|---|---|
| Cleaning | None | $39 |
| Filling | None | $62 |
| Crown | None | $505 |
| Root Canal | None | Discount 20% |
Careington Discount Dental and Vision Plan with EyeMed Vision
Participant$7.95/mo
Plus One$12.95/mo
Family$19.95/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- This is a Discount Plan.
- Plan Maximum:
- ** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
| Waiting | You Pay | |
|---|---|---|
| Cleaning | None | $42 |
| Filling | None | $66 |
| Crown | None | $537 |
| Root Canal | None | Discount 20% |
Careington Maximum Access Discount Dental Plan
Participant$12.95/mo
Plus One$18.95/mo
Family$24.95/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- This is a Discount Plan.
- Plan Maximum:
- ** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
| Waiting | You Pay | |
|---|---|---|
| Cleaning | None | $29 |
| Filling | None | $51 |
| Crown | None | $473 |
| Root Canal | None | Discount 20% |
Careington Maximum Access Discount Dental & Vision Plan with EyeMed Vision
Participant$14.95/mo
Plus One$20.95/mo
Family$26.95/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- This is a Discount Plan.
- Plan Maximum:
- ** These fees represent the average of the assigned Careington Care 500 Series & Care Series fees.
| Waiting | You Pay | |
|---|---|---|
| Cleaning | None | $29 |
| Filling | None | $51 |
| Crown | None | $473 |
| Root Canal | None | Discount 20% |
Dentaflex Advantage Plus PPO
Participant$24.71/mo
Plus Spouse$36.41/mo
Plus Child(ren)$50.42/mo
Family$67.94/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- No Deductible
- Plan Maximum:
- $300 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80% |
| Filling | None | 0% |
| Crown | None | 0% |
| Root Canal | None | 0% |
Max Essentials PPO
Participant$40.38/mo
Plus One$72.97/mo
Family$141.68/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services
- Plan Maximum:
- $750 per person per policy year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 100% |
| Filling | 6 months | 50% |
| Crown | None | 0% |
| Ortho | None | 0% |
Dental for Everyone Gold Plan Delta Dental PPO
Participant$43.06/mo
Plus One$79.22/mo
Family$115.38/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year.
- Plan Maximum:
- $1000 per person per calendar year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 60%-100% |
| Filling | 6 months | 50%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | N/A | 0% |
Dental for Everyone Gold Plan Delta Dental Premier
Participant$53.80/mo
Plus One$100.15/mo
Family$146.51/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year.
- Plan Maximum:
- $1000 per person per calendar year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 60%-100% |
| Filling | 6 months | 50%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | N/A | 0% |
Dentaflex Select PLUS 1500
Participant$54.41/mo
Plus Spouse$95.81/mo
Plus Child(ren)$109.39/mo
Family$163.23/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year. *The deductible is waived in-network on preventative services
- Plan Maximum:
- $1,500 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 100% / 70% |
| Filling | 6 months | 80% / 70% |
| Crown | 12 months | 60% / 50% |
| Root Canal | 12 months | 60% / 50% |
Dental for Everyone Platinum Plan Delta Dental PPO
Participant$54.48/mo
Plus One$101.49/mo
Family$148.51/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. Separate $100 lifetime for Orthodontic Procedures.
- Plan Maximum:
- $1500 per person per calendar year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Filling | 6 months | 60%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | 12 months | 0%-50% |
Dental for Everyone The No Wait Plan Delta Dental PPO
Participant$56.44/mo
Plus One$105.30/mo
Family$154.17/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year
- Plan Maximum:
- $2,000 per person per calendar year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Sealants | None | 40%-80% |
| Crown | None | 15%-50% |
| Ortho | N/A | 0% |
Dentaflex Select PLUS 2000
Participant$57.21/mo
Plus Spouse$101.41/mo
Plus Child(ren)$112.87/mo
Family$169.67/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year. *The deductible is waived in-network on preventative services
- Plan Maximum:
- $2,000 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 100% / 70% |
| Filling | 6 months | 80% / 70% |
| Crown | 12 months | 60% / 50% |
| Root Canal | 12 months | 60% / 50% |
Dental for Everyone Diamond Plan Delta Dental PPO
Participant$58.76/mo
Plus One$109.81/mo
Family$160.88/mo
- Office Co-Pay:
- $25 Copay Per Person Per Visit
- Plan Deductible:
- $150 lifetime deductible for Ortho
- Plan Maximum:
- $2,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Filling | 6 months | 60%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | 12 months | 0%-50% |
MAX Choice Plan PPO/MAC
Participant$58.78/mo
Plus One$106.24/mo
Family$158.59/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services and orthodontics
- Plan Maximum:
- $1,200 per person per policy year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 100% |
| Filling | None | 20%-50% |
| Crown | None | 20%-50% |
| Ortho | None | 10%-50% |
Dental for Everyone Platinum Plan Delta Dental Premier
Participant$68.44/mo
Plus One$128.71/mo
Family$188.98/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. Separate $100 lifetime for Orthodontic Procedures.
- Plan Maximum:
- $1,500 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Filling | 6 months | 60%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | 12 months | 0%-50% |
Dentaflex Classic 1500 Plan
Participant$69.23/mo
Plus One$123.96/mo
Family$218.63/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year.
- Plan Maximum:
- $1,500 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80% |
| Filling | 6 months | 80% |
| Crown | 18 months | 50% |
| Root Canal | 18 months | 50% |
Dentaflex Classic 1500 Plan
Participant$69.23/mo
Plus One$123.96/mo
Family$218.63/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year.
- Plan Maximum:
- $1,500 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80% |
| Filling | 6 months | 80% |
| Crown | 18 months | 50% |
| Root Canal | 18 months | 50% |
Dentaflex Classic 2000 Plan
Participant$73.72/mo
Family$132.83/mo
Family$235.08/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year.
- Plan Maximum:
- $2,000 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80% |
| Filling | 6 months | 80% |
| Crown | 18 months | 50% |
| Root Canal | 18 months | 50% |
Dentaflex Classic 2000 Plan
Participant$73.72/mo
Plus One$132.83/mo
Family$235.08/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per calendar year. $150 Family per calendar year.
- Plan Maximum:
- $2,000 Per Person Per Calendar Year
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80% |
| Filling | 6 months | 80% |
| Crown | 18 months | 50% |
| Root Canal | 18 months | 50% |
Dental for Everyone Diamond Plan Delta Dental Premier
Participant$73.92/mo
Plus One$139.37/mo
Family$204.84/mo
- Office Co-Pay:
- $25 Copay Per Person Per Visit
- Plan Deductible:
- $150 lifetime deductible for Ortho
- Plan Maximum:
- $2,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Filling | 6 months | 60%-80% |
| Crown | 12 months | 0%-50% |
| Ortho | 12 months | 0%-50% |
Dental for Everyone Immediate Coverage Plan Delta Dental PPO/Premier
Participant$85.44/mo
Plus One$161.83/mo
Family$238.24/mo
- Office Co-Pay:
- $25 Copay Per Person Per Visit
- Plan Deductible:
- $150 lifetime deductible for Ortho
- Plan Maximum:
- $3,000 Per Person Per Calendar Year/$1,500 Lifetime Ortho Max
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 80%-100% |
| Filling | None | 60%-80% |
| Crown | None | 10%-50% |
| Ortho | 12 months | 0%-50% |
MAX Choice Plus Plan PPO
Participant$89.49/mo
Plus One$163.15/mo
Family$230.57/mo
- Office Co-Pay:
- N/A
- Plan Deductible:
- $50 per person per policy year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services and orthodontics
- Plan Maximum:
- Policy Year Maximum: 1st year-$1,000 2nd year-$2,000 3rd year-$3,000
| Waiting | Plan Pays | |
|---|---|---|
| Cleaning | None | 100% |
| Filling | None | 20%-50% |
| Crown | None | 20%-50% |
| Ortho | None | 10%-50% |
Child & Related Pages – Site Map
These Q & A’s are from a page that was outdated and we culled it.
6 comments on “Dental – Optional Coverage”
Here’s the Find A Doctor search feature. Select Liberty Dental as that is what the Evidence of Coverage shows on page 80. Then use the Liberty Dental Provider Finder. Put in your zip code, individual MAPD plan and get a list of participating dentists.
Here’s the Blue View Vision Provider Search Engine.
I am thinking of going to a dentist who takes most ppo plans. I am pretty sure I have no dental coverage at present. (I would appreciate your double checking on that since I just switched to medicare with a supplement and am not sure everything that is covered.)
1. Is dental insurance a good deal for me? I.E.
2. how much would it cost and how much would it save me?
I would appreciate it if you could let me know my options.
Thank you in advance for your time.
Jim
In general none of these plans cover dental, although there is coverage for accidents and thus the Plan F would pay it’s share too.
In general, we do not recommend dental. There are annual limits of say $1,000 to $1,500. When I earned my Bachelor’s Degree in Insurance, we were taught that Insurance was for unexpected major financial losses that one could not budget for. I don’t believe dental falls into that category. Take a look at Long Term Care, Life Insurance & Estate Planning. Many of the Medicare Advantage Plans (HMO) offer dental as an option.
To get a comparison of dental plans, full details and enrollment we suggest you use our affiliate website of Dental for Everyone.
Thanks for the links to the various dental pages on your websites and Insurance Company quotes & brochures, however after reviewing even the most expensive one I have decided that all dental insurance is absolutely horrible and not worth a penny.
I can’t believe this is not covered in Medicare
Medicare only has so much money to fund benefits. The $144 you pay for Part B Outpatient or say $33 for Part D Rx only pays 25% of what it costs Medicare to provide the benefits to you.
Heck, check out the Part D Rx survey price comparisons we did for a client with MS Multiple Sclerosis https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/lis-discounts/#comment-25550
The retail annual cost of her Rx is $20k – Part D would pay $15k and she’s only paying around $35/month for coverage. Where does the rest of the money come from?
Here’s our webpage on MLR Medical Loss Ratio https://individuals.healthreformquotes.com/aca/medical-loss-ratio-mrl/
Basically, Insurance Companies have to collect $1 to pay out 80c in benefits.
Here’s a You Tube video I did to explain MLR https://youtu.be/G3WjA9sCobE
Here’s a graph from the Kaiser Foundation showing the costs and what percentage is actually being paid, when you pay your Medicare premiums.
Medicare in 2014 with paying out $19,000 per beneficiary
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet
Here’s a video we did on the value and benefits of Dental Coverage https://youtu.be/FxLzl7C3uYk
Being as the maximum payouts are say $1,500/year… I don’t want to sound like I’m on my high horse, but that’s not what I went and got a degree at San Diego State in Insurance for. IMHO there are other coverages that are more financially devastating to be insured against.
I do agree that Oral Health is very important… Funding it, well that’s beyond my pay grade. I will point out that in the past month, other people have been upset with the limitations of dental coverage. I myself have double the # of times/day I brush and floss. I should be using the water pic too.
see full article https://www.blueshieldca.com/employer/plans/dental-vision-life/dental-infographic.sp
More on tmj complications
https://www.williamssquaredental.com/services/general-dentist/general-dentistry/tmd
I was at my daughters and playing with my 4 year old grandson when his head hit me in the mouth and knocked my front tooth out.
Is this accident covered by Medicare or medi Cal?
I don’t see anywhere, where it seems to be covered under Medicare. Do you have a Medicare Advantage plan? Did you want to look into one? Try Checking with your dentist.
Here’s our information on Medi-Cal Dental Medi-Cal dental benefits were fully restored in January 2018. If you have further questions on Medi-Cal Dental Benefits, please ask on that page.
What county do you live in?
What Medi-Cal Dental Program do you have? If you didn’t select a dental plan, you can probably do it now.
I fell and hit my jaw. I went to the Dr. and x-rays and cat scan done. No broken bones. But I am having teeth pain that just comes and goes and pain in the joint of the jaw. If I go to a dentist or oral surgeon to determine if I did any damage to my teeth, is this covered?
Since it seems that your jaw wasn’t injured, my guess is no coverage. I simply reviewed the links above.
Namely, it appears in your case Medicare only covers:
Surgery to treat fractures of the jaw or face
Which apparently you don’t have.
I’m not a doctor, dentist or authorized Medicare employee. I suggest you check with your dentist.
Had emergency dental care on disc in jaw muscle. Would this be covered under medicare
I’m going to need more information as to why this was an “emergency.” Was this a
temporomandibular-disorders/internal-temporomandibular-joint-derangement
TMJ?
Was there an accident?
Trauma?
Prior symptoms?
Was this done in a hospital or dental office?
What did your dentist say?
Claims were submitted to BCBS of Florida who says we should have first submitted the claim to Medicare.
What do you recommend?
****We’ve answered your question on this new page.