Medicare Does Not Cover Routine Dental Care

Original Medicare (Part A and Part B) does not pay for cleanings, fillings, root canals, crowns, dentures, or other routine dental work. This is true whether you receive SSDI or not. If you are on SSDI and enrolled in Original Medicare, you will pay the full cost of dental care out of pocket unless you have separate dental coverage.

The only dental services Original Medicare covers are those tied to a hospital stay or a specific medical condition. For example, if you need tooth extraction before heart surgery and that extraction happens in a hospital, Medicare may cover the extraction as part of the surgical preparation. These situations are rare and require the dental work to be medically necessary for treatment of a non-dental condition.

Many people on SSDI assume Medicare covers dental because they are used to Medicare covering medical care. The gap exists because Congress did not include dental in the original Medicare law, and it has not been added since. You will need to find dental coverage separately.

Key Takeaways

  • Original Medicare does not cover cleanings, fillings, crowns, dentures, or other routine dental work, even if you receive SSDI.
  • Medicare Advantage plans (Part C) sometimes include dental coverage, but the scope and cost vary widely by plan and location.
  • Medicaid covers dental care in most states, and you may may have access to for both Medicaid and Medicare at the same time if your income is low enough.
  • Dental discount plans and community health centers offer lower-cost alternatives if you cannot afford full-price dental care.
  • You must enroll in a plan that includes dental coverage during the open enrollment period, or you may have to wait until the next year.

Medicare Advantage Plans May Include Dental

Some Medicare Advantage plans (Part C) do include dental coverage as an added benefit. These are private insurance plans that contract with Medicare to cover the same services as Original Medicare, plus extras. The dental benefit varies: some plans cover only cleanings and exams, while others include fillings and extractions. A few cover more expensive work like crowns or root canals, though usually with a higher copay or annual limit.

If you are on SSDI and considering a Medicare Advantage plan, you need to check the dental benefit details for each plan in your area. Plans change their benefits every year, and what one plan covers in your county may not be available in a neighboring county. You can compare plans and their dental benefits on Medicare.gov, or call 1-800-MEDICARE to speak with someone who can walk you through the options.

Switching to a Medicare Advantage plan with dental coverage requires you to enroll during the Annual Enrollment Period (October 15 to December 7 each year). If you miss this window, you cannot switch plans until the next year, with limited exceptions. If you already have Original Medicare and want dental coverage, you will need to wait for the next enrollment period unless you may have access to for a Special Enrollment Period due to a life event.

Medicaid Covers Dental in Most States

Medicaid is a separate program from Medicare, and it covers dental care in most states. If your income is low enough to may have access to for Medicaid, you can have both Medicaid and Medicare at the same time. This combination is sometimes called "dual may be able to access." Medicaid's dental coverage varies by state: some states cover only emergency dental work and extractions, while others cover cleanings, fillings, and other routine care.

To find out whether you may have access to for Medicaid and what dental services it covers in your state, contact your state Medicaid office. You can find the phone number and website for your state on Medicaid.gov. The income limit for Medicaid varies by state and depends on whether you are single or married. In many states, if you receive SSDI, your income is already low enough to may have access to, but you still have to enroll.

Medicaid enrollment does not follow the same calendar as Medicare. You can enroll in Medicaid at any time during the year if you meet the income and other requirements. Once you are enrolled, you can use your Medicaid card to see dentists who accept Medicaid in your state. Not all dentists accept Medicaid, so you may need to call ahead to find one near you.

Community Health Centers and Dental Discount Plans

Federally may have access to Health Centers (FQHCs) are clinics that receive federal funding to provide care to people with low income, regardless of insurance status. Many FQHCs have dental clinics on site or can refer you to one. They charge based on what you can afford to pay, using a sliding fee scale. If you have little or no income, you may pay nothing or a very small amount. You can find an FQHC near you by searching the Health Resources and Services Administration (HRSA) website or by calling 211.

Dental discount plans are membership programs that give you a discount on dental services at participating dentists. They are not insurance, so you pay the full cost of care upfront and then receive a discount (usually 10 to 60 percent off). These plans cost between $80 and $200 per year. They work best if you need a specific procedure and want to reduce the cost. They do not cover emergency care or preventive visits the way insurance does.

Some dental schools also offer low-cost dental care performed by students under the supervision of licensed instructors. The work takes longer than at a regular dentist, but the cost is much lower. Search for "dental school near me" or contact your state dental board to find programs in your area.

How to Enroll in a Plan With Dental Coverage

If you have Original Medicare and want to switch to a Medicare Advantage plan that includes dental, you must enroll during the Annual Enrollment Period. This runs from October 15 to December 7 each year. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or by mail. You will need your Medicare card and information about your current coverage.

When you compare plans, look at the dental benefit details, not just the monthly premium. A plan with a low premium might have a high copay for dental work or a low annual limit. Check whether your current dentist is in the plan's network, because switching dentists can be inconvenient. If you do not have a dentist, ask the plan for a list of dentists in your area who accept that plan.

If you think you may have access to for Medicaid, contact your state Medicaid office to enroll. You can enroll at any time. Bring proof of income (recent pay stubs, tax return, or a letter from Social Security showing your SSDI amount) and proof of citizenship or legal residency. Once you are enrolled, you will receive a Medicaid card in the mail, usually within two to four weeks.

What to Do if You Need Dental Care Now

If you need dental care before you can enroll in a plan with dental coverage, contact a community health center or dental school in your area. Both can see you quickly and charge based on what you can afford. If you have a dental emergency (severe pain, infection, or broken tooth), go to an emergency room or urgent care clinic. They can treat the emergency and may refer you to a dentist for follow-up care.

If you are waiting to enroll in Medicaid, ask the dentist whether they accept Medicaid. Many dentists will hold off on billing until they know whether Medicaid will cover the work. Tell the dentist your expected Medicaid enrollment date so they can plan accordingly. Do not delay emergency care while waiting for coverage to start.

Frequently Asked Questions

Can I get dental coverage if I am already on Original Medicare?

Yes, but you must switch to a Medicare Advantage plan that includes dental. You can only make this switch during the Annual Enrollment Period (October 15 to December 7). If you miss this window, you will have to wait until next year unless you may have access to for a Special Enrollment Period due to a life event like moving or losing other coverage.

Does SSDI income count toward Medicaid may be able to access?

Yes. Your SSDI payment is counted as income when determining whether you may have access to for Medicaid. In most states, if your SSDI payment is below the Medicaid income limit, you will may have access to. Income limits vary by state, so contact your state Medicaid office to find out the exact limit and whether you may have access to.

What if my Medicare Advantage plan stops covering dental?

Plans can change their benefits each year. If your plan drops dental coverage, you will be notified in writing before the change takes effect. You can then switch to a different Medicare Advantage plan during the Annual Enrollment Period, or switch back to Original Medicare. You will have time to make a new choice before the change happens.

Are dental discount plans worth it if I only need one procedure?

It depends on the procedure and the discount. If you need a $1,000 crown and a discount plan gives you 40 percent off, you save $400, which may be more than the annual membership cost. But if you only need a cleaning, the discount may not be worth the membership fee. Calculate the savings before you join.

Can I use my SSDI to pay for dental care?

Yes. Your SSDI payment is yours to spend as you choose. You can use it to pay for dental care directly, or you can use it to pay the monthly premium for a Medicare Advantage plan or other insurance that covers dental. There is no restriction on using SSDI for dental expenses.