Does Medigap Cover Dental? How to Get Coverage

Medigap, also known as Medicare Supplement Insurance, helps individuals manage healthcare costs not covered by Original Medicare, specifically the “gaps” left by Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Many Medicare beneficiaries are concerned about covering various health services, including dental care.

Understanding Medigap Coverage

Medigap policies are sold by private insurance companies and work with Original Medicare. They cover out-of-pocket expenses like deductibles, copayments, and coinsurance. For example, Medicare Part A covers inpatient hospital stays, and Part B covers doctor services and outpatient care, but these parts typically only cover about 80% of approved costs, leaving 20% to the beneficiary. All Medigap plans are standardized; policies with the same letter designation (e.g., Plan G, Plan N) offer the same basic benefits regardless of the insurer or location. To purchase a Medigap policy, you must be enrolled in both Medicare Part A and Part B.

Medigap and Dental Care

A common misconception is that Medigap plans cover routine dental care. Medigap policies only cover services that Original Medicare itself covers. Since Original Medicare generally does not cover routine dental services like cleanings, fillings, or extractions, Medigap policies typically do not cover them either. Limited exceptions exist where Original Medicare might cover dental services, and Medigap would then help with associated out-of-pocket costs. These exceptions usually involve dental work medically necessary as part of another Medicare-covered procedure, such as a dental examination before a kidney transplant.

Options for Dental Coverage

Given that Medigap policies do not generally cover routine dental care, individuals often need to seek alternative solutions to manage these costs.

Standalone Dental Insurance

One option is to purchase a standalone dental insurance policy. These are separate plans designed to cover dental services, often categorizing benefits into preventive care (like cleanings and exams), basic procedures (like fillings), and major procedures (like crowns or root canals). These policies typically involve monthly premiums and may have deductibles, copayments, or annual maximums on coverage.

Medicare Advantage (Part C) Plans

Another option is Medicare Advantage (Part C) plans. Unlike Medigap, Medicare Advantage plans are an alternative way to receive Medicare benefits and often include additional benefits not covered by Original Medicare, such as dental, vision, and hearing care. Many Medicare Advantage plans offer dental benefits that can include routine exams, cleanings, X-rays, fillings, and even dentures, though specific coverage and network requirements vary by plan.

Dental Discount Plans

Dental discount plans offer another way to reduce dental expenses. These are not insurance but membership programs where you pay an annual fee to receive discounted rates on services from a network of participating dentists. Discounts can range from 10% to 60% off typical costs, and these plans usually have no annual limits, deductibles, or waiting periods.

Community Resources

For those seeking lower-cost dental care, community dental clinics and dental schools can be valuable resources. Community health centers often provide services on a sliding fee scale based on income, making care more affordable. Dental schools offer treatment at reduced rates, as procedures are performed by students under the supervision of experienced faculty. While waiting times might be longer, these settings can provide quality care at a fraction of the cost.