Medicare's Coverage of Dental Services

In most cases, Medicare does not cover dental services, specifically, services related to the care, treatment, filling, removal, or replacement of teeth, or structures directly supporting teeth. This would include check-ups, cleanings, and dental devices (such as dentures, dental plates, dental implants, or bridges) as well as extractions or other procedures performed to prepare the mouth for dentures (including reconstruction of the ridge) or titanium implants.

Medicare does not change its coverage based on how complex, difficult or necessary the care may be.  For example, removing or replacing teeth that are impacted or broken would not be covered, even though the services are medically necessary. In addition, if a patient is hospitalized for treatment, it would not automatically allow coverage to exist.

Medicare may cover dental services specifically related to:

• Treatment of a fractured jaw
• Cancer treatment
• Extraction of teeth PRIOR to radiation treatment of the jaw (but not after)
• Dental exam PRIOR to a kidney transplant or heart valve replacement
• Removal of oral lesions or tumors

If a covered procedure is performed in connection with an excluded service, such as preparing the mouth for dentures, both services are non-covered. If a non-covered service or procedure is an essential part of a covered service or procedure, such as removal of a tooth that is preventing the removal of a tumor, both services may be covered. You should contact your provider to determine if a specific service or procedure is covered by Medicare.  

Generally speaking, dental services not covered by Medicare are also not covered by group health plans (health plans offered to individuals or spouses who are still working), supplemental plans or secondary coverage insurance. However, if applicable, it is advisable that you check with your specific plan to be sure, as plans can differ from each other.

If you have questions about what Medicare will pay for dental services, you can call our Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Representatives are available.

We encourage you to visit our Facebook page at www.facebook.com/myrrmedicare. We also invite you to join our listserv/email updates. Just select the ‘Listservs’ link at the top of our website at www.PalmettoGBA.com/RR/Me.