Dental Benefits Expanding in Original Medicare

Original Medicare does not cover routine dental care, whereas some Medicare Advantage plans do. This is a big draw for MA plans. Original Medicare is not allowed to offer such coverage, contributing to a widespread view that the government is stacking the deck in favor of private insurance plans.

Original Medicare does, however, cover dental surgery related to other health problems that are covered by Medicare. The extent and consistency of such coverage regularly disappoint dental groups, and they view the enhancements to this coverage as a major win.

Here is the explanation from the Centers for Medicare & Medicaid Services (CMS) of key changes in Medicare dental coverage it announced in 2023:

“Medicare Part B currently pays for dental services when that service is integral to medically necessary services required to treat a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury or tooth extractions done in preparation for radiation treatment for jaw cancer. CMS is proposing to pay for dental services, such as dental examination and treatment preceding an organ transplant.

In addition, CMS has sought comment on other medical conditions where Medicare should pay for dental services, such as for cancer treatment or joint replacement surgeries, as well as on a process to get public input when “additional dental services may be integral to the clinical success of other medical services.”

A consortium of more than 230 health and senior advocacy groups applauded the proposals. “This important announcement marks a new day in the health of Medicare beneficiaries,” said consortium member Dr. Michael Alfano, with the Santa Fe Group. “Thanks to the tireless work of literally hundreds of organizations and thousands of dedicated advocates, Americans will no longer lack access to medically necessary oral and dental treatment within the traditional Medicare program.”

All Medicare beneficiaries, including those with MA plans, will benefit from broader coverage of medically needed dental care. The changes won’t take effect anytime soon, but do represent a major advancement in oral health for tens of millions of older and disabled people.