Medicare Vs Medicaid: Dental Coverage Explained

Understanding how dental care works with Medicare and Medicaid can save you money and headaches.

Yet the rules vary widely depending on your plan, your state, and whether you’re seeking preventive services like cleanings or major work like dentures and implants.

Medicare and dental coverage: what’s included (and what isn’t)

Original Medicare (Parts A and B) generally does not cover routine dental care such as cleanings, fillings, extractions, dentures, or implants. There are limited exceptions when dental services are considered medically necessary and integral to a covered procedure. For example, Medicare may cover a dental exam prior to a kidney transplant or certain heart valve procedures, or it may cover inpatient hospital services if you need emergency or complicated dental surgery and it must be done in a hospital. See Medicare’s official guidance on dental services at Medicare.gov.

What this means in practical terms: if you rely solely on Original Medicare, you’ll typically pay 100% for routine dental care unless your situation falls into one of those narrow medical-necessity scenarios. Medigap (Medicare Supplement) plans also do not add routine dental benefits; they only help pay Medicare’s cost-sharing for covered medical services. If you want routine or comprehensive dental coverage, you’ll likely need either a Medicare Advantage plan that includes dental or a stand-alone dental plan.

Medicare Advantage (Part C) plans with dental

Many Medicare Advantage (MA) plans include dental benefits ranging from preventive-only (cleanings, exams, X-rays) to comprehensive coverage (fillings, root canals, crowns, dentures, and sometimes implants). Coverage varies a lot by plan and county.

Key details to check before enrolling:

Network and dentists: Are your preferred providers in-network? Some plans require you to use specific dentists or obtain referrals.
Annual maximum: Many MA dental benefits cap annual payments (e.g., $1,000–$2,000). After you hit the cap, you pay the rest.
Coverage levels: Preventive may be $0, basic (fillings) might be 50–80% covered, and major services (crowns, dentures, implants) may have higher cost-sharing or be excluded.
Waiting periods and frequency limits: Some plans limit how often you can get certain services (like a crown every 5–7 years) or require waiting periods before major work.
Pre-authorization: Crowns, root canals, implants, and dentures often require pre-approval to guarantee coverage.

Compare plan documents carefully—look for the Evidence of Coverage (EOC) and the plan’s dental rider—to see exactly what’s included and excluded. You can browse and compare Medicare Advantage options using the official Medicare Plan Finder, then click into each plan’s details to review dental benefits, costs, and networks.

Medicaid dental benefits: state-by-state differences

Medicaid dental coverage varies significantly by state, especially for adults. While comprehensive dental coverage for children is mandatory through EPSDT (more below), adult dental services are typically optional for states—so some offer comprehensive benefits, others provide limited or emergency-only care. For a high-level overview, visit Medicaid’s dental benefits page on Medicaid.gov and the mandatory vs. optional benefits explainer here.

Common adult coverage patterns include:

Emergency-only: Coverage for pain relief and extractions when there’s a serious issue like infection.
Limited: Preventive services and basic restorative care with strict limits on frequency or dollar amounts.
Comprehensive (with caps): Preventive, basic, and some major services, often subject to annual dollar caps or prior authorization.

Children and adolescents enrolled in Medicaid receive dental coverage under EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), which requires states to cover necessary dental services to maintain oral health. Learn more about EPSDT at Medicaid.gov. If your household income is too high for Medicaid but your child qualifies for CHIP, children’s dental benefits are also included (see the CHIP section below).

How to check your state’s Medicaid dental coverage

Start at Medicaid.gov: Review the dental benefits overview here and then visit your state Medicaid website (find contacts here).
Look for your state’s dental fee schedule and member handbook: These documents spell out covered services, frequency limits, and prior authorization rules.
Call the member services number: Ask whether the benefit is emergency-only, limited, or comprehensive, and request a list of in-network dentists.
If you’re in a managed care plan: Check your specific plan’s Evidence of Coverage and provider directory, as rules can vary across plan contractors within the same state.

CHIP and children’s dental care

Children’s dental coverage is a required benefit in both Medicaid (via EPSDT) and the Children’s Health Insurance Program (CHIP). That typically includes preventive services (exams, cleanings, fluoride, sealants), X-rays, fillings, and medically necessary orthodontia in some cases. To learn about your state’s children’s dental benefits and find participating dentists, visit InsureKidsNow.gov.

Practical ways to save on dental care

Prioritize preventive care: Cleanings, fluoride, and sealants help avoid costly procedures later. Many Medicare Advantage plans cover preventive dental at $0 copay, and most Medicaid programs emphasize prevention for kids and often for adults where covered.
Use community health centers: Federally Qualified Health Centers (FQHCs) offer sliding-fee dental services. Find a nearby center using the HRSA locator: findahealthcenter.hrsa.gov.
Consider dental school clinics: Dental students (supervised by licensed faculty) provide care at reduced cost—ideal for non-urgent needs like cleanings, fillings, and some prosthodontics. The NIH offers guidance on low-cost options here.
Ask about treatment tiers: There may be less expensive, clinically appropriate alternatives (e.g., a filling or inlay vs. a crown). Request a written treatment plan with itemized codes and costs.
Verify pre-authorizations: For crowns, root canals, dentures, or implants, confirm your plan’s pre-approval in writing before treatment begins to avoid denials.
Shop stand-alone dental plans carefully: If your Medicare Advantage plan lacks robust dental, a stand-alone plan could help—but check annual maximums, waiting periods, and network access.
Leverage community programs: Local public health departments, dental societies, and nonprofit clinics run periodic free or low-cost events.

Approvals, coding, and billing: how to avoid surprises

Most coverage disputes come down to documentation and codes. Ask your dentist for a pre-treatment estimate with CDT procedure codes, narrative notes, and any X-rays your plan requires. Keep copies of everything and verify that the provider will submit the claim to the correct payer (Medicare Advantage dental administrator or your Medicaid plan).

For hospital-based dental care (e.g., surgery under general anesthesia for complex extractions), clarify whether the facility and anesthesia are covered under medical benefits while the dental work itself may fall under dental benefits—or not at all. Your provider can help determine which elements are billed to medical vs. dental and whether pre-authorization is required.

Common scenarios and what usually happens

“Will Original Medicare pay for my cleaning?” Generally no. Routine preventive dental is excluded under Original Medicare.
“I need a tooth extraction before heart valve surgery—covered?” The medical exam and hospital services related to the covered heart procedure may be covered, but the dental extraction itself is often not, unless Medicare deems it integral to the covered procedure. Review details at Medicare.gov and get written confirmation from your care team.
“Are implants covered?” Many Medicare Advantage plans exclude implants or cover them with strict limits. Some Medicaid programs do not cover implants for adults; others may cover in very limited circumstances. Always verify specifics.
“What about dentures?” Denture coverage varies: some MA plans offer partial coverage up to an annual max; some Medicaid programs include dentures for adults, often with prior authorization.
“Can I keep my dentist?” With MA or Medicaid managed care, you may need to switch to an in-network dentist to receive full benefits. Ask your dentist which plans they accept before you enroll or schedule care.

Action steps to get the right dental coverage

If you have Original Medicare only: Decide if a Medicare Advantage plan with dental or a stand-alone dental plan fits your needs and budget. Use the Plan Finder to compare benefits and provider networks.
If you have Medicaid: Check your state’s adult dental benefit details and your plan’s provider directory. Start at Medicaid.gov and your state plan’s website.
If you’re seeking care for a child: Explore options and find dentists who accept Medicaid/CHIP at InsureKidsNow.gov.
For cost-sensitive care: Search for FQHCs near you at HRSA’s locator and consider dental school clinics (see NIDCR’s guide).

The bottom line: Medicare’s dental coverage is limited unless you enroll in a Medicare Advantage plan with dental, while Medicaid dental benefits vary widely by state—comprehensive for kids, and anywhere from emergency-only to robust for adults. With a few checks—verifying benefits, confirming networks, and securing pre-authorization for major work—you can avoid surprise bills and get the dental care you need.