Does Plan G Cover Dental Care? 

Original Medicare does not offer routine dental coverage, such as basic services like cleaning and X-rays. When the Medicare program launched in 1965, dental services and devices were excluded. However, there are exceptions to the dental coverage exclusion, and alternatives are available to reduce your out-of-pocket cost.

Covered dental benefits

Generally, Original Medicare will not pay for routine dental services, treatments, fillings, tooth extractions or replacement structures. If you are hospitalized because of a severe and complicated dental procedure or a related underlying health condition, you may qualify for Part A inpatient hospital coverage.

An example of dental services linked to medically necessary procedures is an oral exam as part of a preoperative workup before you undergo an organ transplant, a cardiac valve replacement or a valvotomy. Other services that may qualify for coverage are dental ridge reconstruction resulting from a tumor, stabilization of teeth to mitigate jaw fracture, dental splints for dislocated jaw joints, and tooth extractions as preparation for radiation to treat cancer.

Medigap and dental care

Medicare Supplement policies, also known as Medigap plans, are add-on coverage, purchased to fill in the gaps in Original Medicare. Even though Original Medicare covers many medical expenses, there are out-of-pocket costs, including copayments, coinsurance and deductibles. There are several Medigap plans to choose from, but Plan G is currently the most comprehensive Medigap plan you can buy. 

Medigap does not close coverage gaps for aspects of healthcare like dental, vision and hearing services. Medigap policyholders can purchase stand-alone dental insurance or dental savings plans, but many people find that having several different policies to manage can feel overwhelming. 

Dental care with Medicare Advantage 

An alternative to Original Medicare is Medicare Advantage (Medicare Part C). MA plans are offered by private companies who contract with Medicare to provide your Parts A and B benefits, along with additional benefits. Many MA plans include dental care services and more. 

MA plans are popular because they offer a one-stop-shopping experience. Many Medicare Advantage (MA) plans encompass benefits outside the realm of Original Medicare, such as vision, hearing, fitness and dental services. 

Depending on your location, you might find an MA plan that includes dental care. However, you may have to use a dentist in the plan’s network. Read  your plan’s summary to understand the benefit cap, cost-sharing and covered expenses. If you have dental insurance, using a network dentist is the most cost-effective and convenient approach because the dentist bills the insurer directly and can only charge you back what the plan allows. 

Why dental care is important 

While performing a routine oral exam, your dentist can detect signs of infection, disease and nutritional deficiency. The Mayo Clinic warns that oral health may contribute to ailments like pneumonia and heart disease. Health conditions impacting oral health include diabetes, HIV/Aids, osteoporosis and Alzheimer’s disease. According to the American Dental Association (ADA), “your mouth is a window into the health of your body.”

Some people find dental expenses cost-prohibitive, especially older adults requiring major dental services due to gum disease or bone loss. As you weigh the pros and cons of dental coverage options, consider consulting with a qualified insurance agent to check availability in your area and match a plan that meets your needs.