Finding a dentist who takes your Medicare coverage might mean a long drive or a short walk.
Seniors with Medicare Parts A and B face extreme obstacles.
Their plan covers dental work only in specific cases and with a small group of approved providers. The government directory shows only a few providers over large areas.
Seniors with Medicare Part C have a smoother process if their Advantage Plan includes dental benefits.
Check your private insurance company’s online directory. Input your zip code and dental specialty to get a list of in-network providers.
Medicare Parts A & B
Finding a dental office that accepts Medicare Parts A or B can be arduous and may require a long trip. Few providers enroll in the program because it does not pay for most oral care services.
Find out which dental services Medicare Parts A and B cover and how providers can join the program. Use an online search to find enrolled offices.
Medicare Directory
The government has an online directory of providers in Medicare Parts A and B. Dental offices must enroll to get paid for covered services and can be participating or non-participating.
Use this online portal to search for local dentists accepting Medicare. Select “Doctors & Clinicians” to find general information about offices enrolled in Medicare.
Generate a list of local providers by entering your zip code, city, or state in the first box. Click “Browse all specialties” in the second box and select the one that fits your needs. A third box will appear with the distance from your home.
Here are the results we found for East Brunswick, a town in central NJ, situated between two large cities: New York (40 miles) and Philadelphia (60 miles). The listing you receive will vary.
| Specialty | 10 Mile | 25 Miles | 50 Miles | 100 Miles |
|---|---|---|---|---|
| Dental Anesthesiology | 0 | 0 | 0 | 0 |
| Dental Public Health | 0 | 0 | 0 | 0 |
| General Dentist | 1 | 1 | 46 | 58 |
| Oral Medicine | 0 | 0 | 1 | 1 |
| Oral Surgery | 4 | 28 | 182 | 300 |
| Orofacial Pain | 0 | 0 | 2 | 2 |
| Orthodontics | 0 | 0 | 0 | 0 |
| Pediatric Dentistry | 0 | 0 | 0 | 0 |
| Periodontist | 0 | 0 | 1 | 1 |
| Prosthodontics | 0 | 0 | 0 | 0 |
Emergency Dentists
Emergency dentistry is not a Medicare specialty. The online directory won’t list enrolled offices handling urgent matters.
An emergency dentist handles urgent dental problems requiring immediate attention, like severe pain or trauma. Because time is crucial, you should recognize when Medicare Part A and B will cover treatment and when it will not.
- Medicare may cover dental emergencies caused by trauma, such as immobilizing teeth when reducing a jaw fracture.
- Medicare does not cover dental emergencies caused by tooth decay or infection, such as root canal treatment.
Pediatric Dentists
Pediatric dentistry is a Medicare-approved specialty. However, our initial list had zero providers within 100 miles. When we expanded the search to 200 miles, we still came up empty, raising an interesting question.
Why do pediatric dentists in Delaware, New Jersey, Connecticut, and major cities such as New York, Philadelphia, Baltimore, and Washington, D.C., not bother to enroll in Medicare?
Medicare does not cover children unless they have end-stage renal disease. Only about nine out of a million children suffer from kidney failure. Perhaps the patient population is too small to warrant completing the enrollment paperwork.
Medicaid covers pediatric dentistry nationwide. Low-income families will find it easier to find participating providers in this program.
Prosthodontists
Prosthodontics is a Medicare-approved specialty. However, we could not find any enrolled prosthodontists within 100 miles of our address in East Brunswick.
Prosthodontists focus on restoring and replacing missing or damaged teeth and other oral structures. Medicare Parts A and B rarely pay for implants or dentures, perhaps explaining the dearth of enrolled providers.
You may need to explore alternatives.
- Seniors can lower dental implant costs through tax savings, charitable organizations, or by purchasing specific insurance plans.
- Seniors might get zero-cost dentures if they are dual-eligible with Medicaid. Thirty-three states support dentures for adults.
Oral Surgery
Oral surgery is the only Medicare-approved specialty with many enrolled offices that don’t require travel to big cities like New York or Philadelphia. There must be a reason.
Medicare Part B covers oral surgery when medically necessary, including specific tooth extractions and corrective jaw surgeries.
Oral surgery offices are more likely to complete enrollment because Medicare Part B covers many of their services.
Covered Services
Dental offices accepting Medicare assignment agree to take the approved amount as full payment for covered services. However, Parts A & B rarely cover oral care.
Medicare does not pay for the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth. However, some limited exclusions may apply.
Inpatient Services
Medicare Parts A and B pay for dental services that require hospitalization because of the patient’s underlying medical condition or the severity of the oral care procedure.
For example, patients with heart disease, diabetes, or compromised immune systems may need hospitalization to ensure their safety during dental procedures.
Integral Services
Parts A and B may cover dental services inextricably linked to the clinical success of other Medicare-covered procedures or services.
- Dental treatment to eliminate infection before other covered procedures
- Organ transplant
- Cardiac valve replacement
- Valvuloplasty widening
- Chemotherapy for cancer
- Dental treatment of complications resulting from covered procedures
- Head and neck cancer using radiation
- Dental ridge reconstruction after surgery
- Immobilize teeth when reducing a jaw fracture
- Dialysis to treat end-stage renal disease
Acceptance Meaning
Enrolled dental offices can relate to Medicare in three ways. Patients with Parts A & B should verify the relationship before starting treatment.
- Participating providers accept assignment, meaning the Medicare-approved amount is full payment for covered services, limiting your out-of-pocket costs to the deductible and coinsurance.
- Non-participating providers reject assignment and can potentially bill more than the Medicare-approved amount, up to a 15% “limiting charge.”
- Opt-out providers have signed an agreement to be excluded from the program. Medicare will not pay for any oral care you receive except in emergencies.
Medicare Part C (Advantage)
More local dentists accept Medicare Part C. Many Advantage plans expand benefits to include dental work: the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth.
Seniors should visit the online directory of the private insurance company issuing their Advantage Plan to find participating dentists near their homes.
AARP
Visit the United Healthcare (UHC) website to create a list of local dentists accepting the AARP Medicare Advantage Plan. UHC is the insurance company behind the branded affiliate program.
Use the UHC online provider directory to find dentists participating in the AARP-sponsored plan. Choose the network associated with your specific coverage and narrow your search by specialty.
- Endodontist
- General practitioner
- Oral Surgeon
- Periodontist
- Prosthodontist
Aetna
Visit the Aetna website to generate a list of local dentists accepting their Medicare Advantage Plan. Before proceeding, check your member ID card for crucial details.
Find Aetna Medicare dentists through their online provider directory. You must select the type of dental benefits you have.
- Network plans cover preventive care 100% (exams, cleanings, X-rays) and sometimes comprehensive services such as fillings and extractions. However, you can only choose participating providers.
- Direct Member Reimbursement (DMR) plans allow you to see any provider that has not opted out of the program and cover preventive and comprehensive services.
BCBS
Visit the website of the correct affiliate to find a list of local dentists accepting your Blue Cross Blue Shield (BCBS) Medicare Advantage Plan. BCBS is not a single entity.
BCBS is a national federation of thirty-seven independently owned and operated insurance companies. Therefore, seniors do not have a one-stop resource.
Examine your BCBS Medicare member ID card. Find the URL of the affiliate issuing your plan. Search for the provider directory on that website.
Humana
Visit the Humana website to find local dentists accepting their Medicare Advantage Plan. Have your member ID ready for the most accurate results.
The Humana Find a Dentist tool allows you to search by zip code and distance. However, you must select the correct network without a member ID number.
- Dental Health Maintenance Organization
- Federal Advantage
- Federal Standard Advantage EPO
- Preferred Provider Organization
- Bright Plus
- Bright Plus for Veterans
- Many Others
