What does Original Medicare pay for dental care?
In most cases Medicare does not cover dental services like routine cleanings, fillings, tooth extractions or items like dentures and implants. You pay all costs for services Medicare does not cover.
- Some dental services you get when you are admitted as a hospital inpatient for your dental procedure, because of your medical condition or the severity of the procedure.
- An oral exam and dental treatment before a heart valve replacement, or a bone marrow, organ or kidney transplant.
- A procedure, such as a tooth extraction, to treat a mouth infection before cancer treatment like chemotherapy.
- Treatment for a complication during head and neck cancer treatment.
- Dental or oral exams, and treatment to remove an oral or dental infection, before and during Medicare covered dialysis if you have end stage renal disease.
Those are the cases where Medicare may cover it. For a Part B covered dental service you pay 20% of the Medicare approved amount after the Part B deductible.
KFF reported in 2021 that 47% of Medicare beneficiaries, about 24 million people, had no dental coverage in 2019, and that those who used dental services paid an average of $874 out of pocket in 2018. These are older figures, so treat them as a picture of the problem, not as 2027 prices.
How does Florida Medicaid cover dental care?
Florida's Agency for Health Care Administration says Medicaid covers much more dental care for people under 21 than for adults.
| Age | What Florida Medicaid reimburses |
|---|---|
| Under 21 | Crowns, diagnostic evaluations, endodontics, full and partial dentures, oral surgery, orthodontic treatment, periodontal services, preventive services, radiographs needed to make a diagnosis, and restorations |
| 21 and older | Acute emergency dental procedures to relieve pain or infection, plus dentures and denture related procedures: a comprehensive oral evaluation, full and partial dentures, incision and drainage of an abscess, radiographs needed for a diagnosis and a problem focused oral evaluation |
The agency calls this part of the minimum covered services for all Managed Medical Assistance plans serving Medicaid enrollees. Ask your plan whether it adds anything beyond that list.
Do marketplace plans include dental?
Florida uses HealthCare.gov. You can pick a marketplace health plan with or without dental benefits, and if you pick one without, you can add a separate dental plan.
- Health plans with dental: some include it, and the premium covers both health and dental benefits. You cannot remove the dental coverage from such a plan, but you can change plans during open enrollment or a special enrollment period.
- Separate dental plans: you pay a separate premium on top of your health premium, and you can cancel a separate dental plan at any time.
- You cannot buy a marketplace dental plan unless you buy a health plan at the same time.
- Dental is an essential health benefit for children 18 and under. It must be available to you, either inside a plan or as a separate plan, but you do not have to buy it. Adult dental is not an essential health benefit.
- Separate dental plans can have waiting periods for adults. During a waiting period you pay premiums and the plan does not cover services, so get the details before you enroll.
Marketplace open enrollment begins November 1, 2026, and a plan picked by December 15, 2026 starts January 1, 2027.
How much dental coverage do Medicare Advantage plans offer?
Many Medicare Advantage plans add dental benefits that Original Medicare lacks. KFF's 2021 review of those plans shows how different they can be.
| Measure | KFF's 2021 finding |
|---|---|
| Enrollees in a plan with access to some dental coverage | 94%, or 16.6 million people |
| Of those, offered both preventive and more extensive dental benefits | 86% |
| Offered more extensive coverage and in a plan with an annual dollar limit | 78%, with an average limit of $1,300 |
| Those with a limit of $1,000 or less | 59% |
| Pay no cost sharing for preventive dental services | 64% of those with access to them |
| Required to pay a separate premium for any dental benefits | About 10% |
KFF says the most common coinsurance for more extensive services, such as fillings, extractions and root canals, is 50%. These are 2021 figures. Plan benefits change every year, so read the 2027 Evidence of Coverage of any plan you are considering.
Which option fits my situation?
| Your situation | Where to start |
|---|---|
| Under 21 with Florida Medicaid | Medicaid covers a broad list of dental care, including crowns, orthodontic treatment and preventive services. |
| 21 or older with Florida Medicaid | Medicaid covers emergency dental care and dentures. Ask your plan about routine care and anything extra. |
| On Original Medicare | Medicare skips routine dental in most cases. Compare a Medicare Advantage plan with dental benefits, or a separate dental plan, during annual enrollment. |
| Buying a marketplace plan | Check which health plans include dental, or add a separate dental plan when you buy your health plan. |
| Covering a child 18 or under | Dental must be available inside a plan or as a separate plan. You choose whether to buy it. |
Medicare's annual enrollment period runs October 15 to December 7, 2026. A Medicare plan picked by December 7 starts January 1.
What should I compare before I choose a dental plan?
- The waiting period before each kind of care is covered.
- The yearly maximum the plan pays, and what you pay after you reach it.
- Your share of cost for cleanings, fillings, root canals and dentures.
- Whether your dentist is in the plan's network.
- The separate premium, if there is one, on top of your health premium.
Dental benefits differ plan by plan, so ask for the details in writing before you enroll.
How can a Florida agent help with dental coverage?
An agent can show which marketplace plans include dental and which separate dental plans are offered, compare Medicare Advantage plans that include dental benefits, and explain waiting periods and yearly maximums before you enroll. Have your dentist's name and the care you expect to need ready.
Health Insurance Solutions agents are licensed in 22 states and help by phone and online. Marketplace plans cost the same with or without an agent, so the comparison does not add to your premium.
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