Medicare Dental Coverage: What Original Medicare Pays For (and What It Doesn't)

Original Medicare doesn't pay for cleanings, fillings, routine extractions, dentures or implants. That's not a coverage gap someone forgot to fix. It's written into federal law: Section 1862(a)(12) of the Social Security Act bars Medicare from paying for services "in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth."

There are exceptions, and they've grown since 2023. If dental work is tied to the success of a covered medical treatment, like a heart valve replacement, an organ transplant, cancer treatment or dialysis, Medicare can pay. So the useful question for anyone on Medicare isn't "does Medicare cover dental?" It's "is this particular dental service linked to a covered medical treatment, and if not, what's paying for it?" Here's how to answer both in Washington.

Source: Medicare.gov, Dental services; CMS, 2026 Medicare Parts A and B premiums and deductibles; KFF, Medicare and Dental Coverage: A Closer Look (2021). CMS hasn't announced 2027 amounts yet.

The rule: what Medicare excludes

The exclusion lives in two places. The statute is Social Security Act §1862(a)(12), and CMS's regulation is 42 CFR 411.15(i). The regulation's basic rule excludes "dental services in connection with the care, treatment, filling, removal, or replacement of teeth, or structures directly supporting the teeth."

"Structures directly supporting the teeth" matters more than it sounds. CMS's dental coverage page says that means the gums, the periodontal membrane, cementum and the alveolar bone that holds the tooth sockets. So gum treatment and bone work around the teeth fall under the same exclusion as fillings.

CMS also lists some services people often assume would be medical, and they aren't. Pulling an impacted tooth is on CMS's list of non-covered examples. So is surgery to prepare the mouth for dentures, such as alveoplasty, ridge reconstruction, frenectomy or removing a torus palatinus (a bony growth on the roof of the mouth). If the end product is a denture, Medicare treats the prep work like the denture itself: excluded.

Source: Medicare.gov, Dental services; CMS, Medicare Dental Coverage; 42 CFR 411.15(i).

Medicare.gov's own summary is blunt: "In most cases, Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions (removals), or items like dentures and implants." For non-covered services, you pay all of the cost.

The exceptions, and when CMS added them

There are two kinds of exceptions.

The hospital exception. The statute itself lets Part A pay for inpatient hospital services connected with dental work when you need to be in the hospital "because of his underlying medical condition and clinical status or because of the severity of the dental procedure." Read that carefully: Part A pays for the hospital stay. It doesn't turn the dental work itself into a covered service.

The "inextricably linked" exception. This is the one that has changed. Under 42 CFR 411.15(i)(3), dental services that are "inextricably linked to, and substantially related and integral to the clinical success of, a certain covered medical service are not excluded." Medicare can then pay under Part A or Part B, in a hospital or in an outpatient setting like a dentist's office. The reasoning is practical: an untreated mouth infection can sink a transplant or a heart valve surgery, so treating it is part of the medical care.

CMS has added to that list through its annual Physician Fee Schedule rules. Here's what's on it now and when each piece arrived.

Source: 42 CFR 411.15(i)(3), current text; CMS Physician Fee Schedule final rule fact sheets for CY 2023, CY 2024 and CY 2025. "When" is the calendar year CMS made payment available; "Before 2023" rows are examples CMS said it already paid for, then codified in the CY 2023 rule.

Anesthesia, X-rays and operating room use that go with a covered dental service are covered too, under the same rule.

Two things the list doesn't include. CMS asked for comments in the 2025 rule on dental care for people with diabetes, autoimmune diseases on immunosuppressive drugs, sickle cell disease and hemophilia, but it didn't adopt payment for any of those. And the CMS fact sheet for the 2027 proposed rule, released July 14, 2026, doesn't mention dental services at all. As of today, the 2025 list is the current list. If CMS changes it in the 2027 final rule, this article gets updated.

What you pay when Medicare does cover it

Covered dental services get normal Medicare cost sharing. Nothing special.

• Part B (outpatient, like a dentist's or oral surgeon's office): 20% of the Medicare-approved amount after the $283 Part B deductible for 2026. In a hospital outpatient department or other facility, you also owe the facility a copayment.
• Part A (inpatient): the $1,736 deductible per benefit period covers days 1 to 60 in 2026. Days 61 to 90 cost $434 a day.

Example (hypothetical): Say your transplant team sends you to a Medicare-enrolled oral surgeon to pull an infected tooth before surgery, and the Medicare-approved amount is $600. If you haven't paid anything toward your Part B deductible yet this year, you pay the first $283, then 20% of the remaining $317, which is $63.40. Your share: $346.40. Medicare pays $253.60. If you'd already met the deductible, your share would be 20% of $600, or $120. A Medigap policy or Apple Health may pick up some or all of your share, because this is now a Medicare-covered service.

Source: CMS, 2026 Medicare Parts A and B premiums and deductibles; Medicare.gov, Dental services.

Medigap doesn't fill this gap

It's easy to assume a Medicare Supplement (Medigap) policy covers "what Medicare doesn't." That's not how it works. Medigap pays your share of costs for services Original Medicare covers: deductibles, coinsurance, copayments. Medicare.gov lists what Medigap plans "generally don't cover," and "vision or dental care" is on that list, along with hearing aids and long-term care.

So Medigap helps with the covered exceptions above, like the 20% on a pre-transplant extraction, depending on the plan letter. It doesn't touch a crown, a cleaning or a set of dentures. If you're weighing Medigap in Washington, our Medicare Supplement guide for Washington covers the state's rules, and the Medicare Supplement page explains the plan letters.

Medicare Advantage and dental

Medicare Advantage (Part C) plans have to cover everything Original Medicare covers, including the dental exceptions above. Medicare.gov says they "may also offer extra benefits that Original Medicare doesn't cover – like some vision, hearing and dental services." CMS's provider page puts it the same way: some plans may cover routine and other dental services as an added benefit.

"May" is the operative word. Dental benefits differ from plan to plan and can change from year to year, and some plans require you to use their network or get approval first. KFF's research found that annual dollar limits on dental coverage in Medicare Advantage are common. When dental is part of why you're looking at a plan, read the plan's Evidence of Coverage for the dental section: what's included, the yearly maximum, the dentist network, and whether bigger work like crowns or dentures is included at all.

Don't pick a health plan for the dental benefit alone. Your doctors, hospitals and prescriptions matter more. Our comparison of Medicare Advantage vs. Medigap in Washington walks through the trade-offs, and Open Enrollment runs October 15 to December 7; see the 2027 Open Enrollment guide for Washington for what you can change.

Apple Health dental for people with Medicare

For people with Medicare and limited income, this is where routine dental coverage in Washington actually comes from.

Apple Health (Washington Medicaid) covers adult dental directly through the ProviderOne services card. Under WAC 182-501-0060, dental services are part of the benefit package for Categorically Needy and Medically Needy coverage, the Classic Medicaid coverage types people on Medicare can qualify for. When you have both, HCA says Apple Health "will work as a secondary insurance to Medicare": Medicare pays first, and Apple Health picks up services Medicare doesn't cover, dental among them.

Source: HCA 22-811, Dental care for adults (01/26); HCA, How do I get dental care?. HCA notes limitations may apply.

Here's the catch that trips people up. The Medicare Savings Programs are also part of Apple Health, but on their own they help with Medicare costs, not dental. HCA's MSP page lists what each one pays: QMB covers Part A and B premiums, deductibles and copayments; SLMB and QI-1 pay the Part B premium. If your approval letter is for an MSP only, don't assume you have Apple Health dental. Full Classic Medicaid for aged, blind or disabled people has much lower limits; HCA's Income and Resource Standards list $994 a month in countable income for one person and a $2,000 resource limit, and spenddown can apply above that. Our Apple Health and Medicare guide lays out every income line.

To find an Apple Health dentist, HCA points to DentistLink (1-844-888-5465) or HCA at 1-800-562-3022. Apply for Classic Medicaid on Washington Connection, at a DSHS Community Services Office, or with paper form 18-005.

Standalone dental coverage and other options

If you're on Original Medicare without Apple Health, the dental bill is yours unless you set up something else, such as an individual dental insurance policy.

Standalone dental policies vary a lot, so compare the terms, not the brochure. In general, look at:

• Annual maximum: the most the policy pays in a year. One crown or a set of dentures can use up a low maximum fast.
• Waiting periods: some policies won't pay for major work, like crowns, bridges or dentures, until you've had the coverage for a set time.
• Coinsurance by category: preventive, basic and major services may be paid at different percentages.
• Network: whether your current dentist participates.
• Exclusions: check whether implants are covered and whether teeth missing before the policy started are excluded.

Then compare the yearly cost of the coverage with what you'd pay the dentist directly. If you only expect two cleanings a year, run the numbers both ways.

Source: Medicare.gov, Dental services; Medicare.gov, What Medigap covers; Medicare.gov, Compare Original Medicare and Medicare Advantage; HCA 22-811; HCA, Medicare Savings Program.

For a sense of scale, KFF found that nearly half of people on Medicare (47%) had no dental coverage of any kind in 2019. Among people on Medicare who used dental services in 2018, the average out-of-pocket cost was $874, and one in five spent more than $1,000.

What to do before dental work

1. Ask why you need it. If a doctor told you to get your mouth checked before a transplant, heart valve surgery, cancer treatment or dialysis, say so to the dentist and ask whether they'll bill Medicare. Get the referral in writing.
2. Ask whether the dentist is enrolled in Medicare. CMS requires it to bill covered dental services, so ask; don't assume.
3. Get the cost in writing first. For services Medicare never covers, the dentist isn't required to give you a notice. CMS's guidance on advance notices says providers "may issue a voluntary notice" as a courtesy. Ask for a written estimate anyway, and ask what happens to the bill if Medicare denies it.
4. Check your other coverage in order. Apple Health card? Medicare Advantage dental benefit? Standalone policy? Find out which one applies before the appointment, not after.
5. If Medicare denies a service you think is linked to covered treatment, you can appeal. Read the denial on your Medicare Summary Notice and ask your doctor for a note on why the dental work was needed for the medical treatment.
6. Talk to SHIBA. SHIBA, the Statewide Health Insurance Benefits Advisors program run by the Office of the Insurance Commissioner, gives "unbiased and confidential help with Medicare" at no cost. Call 1-800-562-6900, 8:30 a.m. to 4:30 p.m. Monday through Friday. SHIBA can also help with appeals.

For broader Medicare questions, see our Washington Medicare page or the Washington insurance FAQ.

FAQ

Does Medicare cover dental?

Original Medicare doesn't cover routine dental care like cleanings, fillings, extractions, dentures or implants. It can cover dental services that are linked to certain covered medical treatments, such as an exam and infection treatment before an organ transplant or heart valve replacement, and some hospital stays for dental procedures.

Does Medicare cover dentures?

No. Original Medicare doesn't cover dentures, and CMS also excludes surgery done to prepare the mouth for dentures. Apple Health covers complete and partial dentures for adults who qualify, and some Medicare Advantage plans or standalone dental policies may include them.

Does Medigap cover dental?

Generally no. Medigap pays your share of costs for services Original Medicare covers. Medicare.gov lists vision or dental care among the things Medigap plans generally don't cover.

When does Medicare pay for a tooth extraction?

When the extraction is linked to a covered medical treatment, such as removing infected teeth before an organ transplant, heart valve replacement, chemotherapy or dialysis, or extracting teeth to prepare the jaw for radiation treatment of cancer. Routine and impacted-tooth extractions aren't covered.

Federal Medicare rules, your own plan or policy documents and Washington law control what's covered. Confirm your situation with Medicare, SHIBA, HCA or a licensed agent before you schedule dental work.

Sources

1. Medicare.gov: Dental services
2. Medicare.gov: What's not covered (Original Medicare)
3. Medicare.gov: Compare Original Medicare and Medicare Advantage
4. Medicare.gov: What Medigap covers
5. CMS: Medicare Dental Coverage
6. eCFR: 42 CFR 411.15, particular services excluded from coverage
7. Social Security Act §1862(a)(12)
8. 42 U.S.C. 1395y (Legal Information Institute)
9. CMS: CY 2023 Physician Fee Schedule final rule fact sheet
10. CMS: CY 2024 Physician Fee Schedule final rule fact sheet
11. CMS: CY 2025 Physician Fee Schedule final rule fact sheet
12. CMS: CY 2027 Physician Fee Schedule proposed rule fact sheet
13. CMS: 2026 Medicare Parts A and B premiums and deductibles
14. CMS MLN006266: Medicare Advance Written Notices of Non-coverage (May 2025)
15. HCA: How do I get dental care?
16. HCA 22-811: Dental care for adults (01/26)
17. HCA: Age 65 and older or Medicare eligible
18. HCA: Medicare Savings Program
19. HCA: Aged, blind, or disabled
20. WAC 182-501-0060: Program benefit packages
21. Washington OIC: SHIBA
22. HCA: Washington Apple Health Income and Resource Standards, Oct. 1, 2026 (HCA 19-0096)
23. KFF: Medicare and Dental Coverage: A Closer Look (2021)