Why Doesn’t Medicare Cover Dental?

Simply put, for a long time, dental work wasn’t considered important enough to be covered by Medicare due to a lack of information and resources.

The U.S. Centers for Medicare & Medicaid Services was established in 1965, and since then, little to no changes have been made to offer dental coverage. Politicians often ignore this coverage gap, and organized dentistry, such as America’s Health Insurance Plans and the American Dental Association, publicly oppose dental coverage through Medicare.

Even though dentistry is now an accepted practice, the coverage of dental care through Medicare isn’t a certainty yet.

For the first time, Medicare coverage for dental could be coming within the next few years. President Biden proposed a 2022 budget request to include dental coverage with Medicare. This would provide dental coverage for 60 million older Americans who previously couldn’t afford to get dental work done.

The American Dental Association is against this proposal due to possible pay cuts, gathering their 162,000 members to oppose dental coverage for all Medicare beneficiaries.

According to the National Library of Medicine, for dental services to be successfully covered by Medicare, dental must be accepted as a part of primary health care. This would require an increase in funds, support from the government and an expansion of the health care workforce.

Even if Medicare doesn’t cover dental services currently, there are still other options to consider, such as private dental insurance, Medicaid or Medicare Advantage.

While this would require you to manage multiple plans, it’s important to note that dental care becomes crucial as you age. Routine preventive visits with your dentist can help catch many serious diseases and conditions early on.

For example, according to an article from Harvard Health Publishing, if you have gum disease, you’re two to three times more at risk for a heart attack, stroke or other heart condition.

A recent Cigna study about dental costs found that on average, those who receive consistent preventive dental care can reduce their total medical bills by 4.4% per year. For those with diabetes, the savings was even higher — an average of 12.25% per year.

It’s best to review price and coverage differences to find the most cost effective dental insurance plan that’s convenient for your needs.

Private dental plans typically cost between $20 to $60 a month, depending on the type of coverage you choose.

Preventive services are usually 100% covered under private dental insurance. Other services, like comprehensive dental work, offer cost sharing options. For example, if you were to undergo a dental bridge procedure, then private health insurance will typically cover 50% to 80% of the cost.

For most comprehensive dental procedures under private insurance, there is a possible waiting period of up to six months. If you need a dental procedure done quicker for health reasons, then another option may be better suited for you.

Most Medicare Advantage plans include dental coverage, along with everything included in Original Medicare.

Many plans cover 100% of preventive services with in-network doctors. For comprehensive levels of dental care, there is normally cost-sharing and out-of-pocket costs.

Since there are different levels of coverage for each Medicare Advantage plan, the price varies. Compare Medicare Advantage plans and prices to ensure they cover the specific treatments you require before choosing a plan.

Medicaid offers healthcare coverage, including dental options, for low-income Americans.

While there is no minimum requirement for adult dental coverage, less than half the states provide comprehensive dental care. Some states, like Maryland, offer no dental coverage at all. However, most states do cover emergency care.

Confirm with the Center for Health Care Strategies Medicaid chart to see if your state covers dental services to avoid unexpected costs.