Medicare doesn’t cover routine dental care because the law that created the program in 1965 explicitly excluded it. 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 the teeth.” That exclusion has remained essentially unchanged for 60 years, leaving most of the 67 million people on Medicare to pay for dental work out of their own pockets.
Why Dental Was Left Out in 1965
When Congress designed Medicare, it modeled the program on the private health insurance of the era. At the time, medical insurance and dental insurance were treated as entirely separate products. Employer-sponsored health plans rarely included dental benefits, so the lawmakers drafting Medicare didn’t consider dental care part of “medical” coverage. The thinking was straightforward, if flawed: teeth were the dentist’s domain, not the doctor’s, and the new program was meant to cover hospital and physician services.
Cost also played a role. Medicare was already a politically difficult program to pass, and adding dental coverage would have raised the price tag significantly. Keeping the scope narrow helped secure enough votes. The result was a statute that treats the mouth as separate from the rest of the body, a distinction that modern medicine increasingly recognizes as artificial. Poor oral health in older adults is linked to higher rates of diabetes complications, cardiovascular disease, respiratory infections, and dementia.
What Medicare Actually Covers
The exclusion isn’t absolute. Medicare Part A can pay for dental services performed in a hospital when your medical condition or the severity of the procedure requires it. And in recent years, CMS has expanded the list of situations where dental care qualifies as “medically necessary” because it’s tied to the success of a covered medical treatment. These exceptions include:
- Organ and bone marrow transplants: oral exams and treatment of dental infections before or during the transplant process
- Heart valve replacement or repair: dental clearance to reduce the risk of infection reaching the new valve
- Cancer treatment: tooth extractions or infection treatment before chemotherapy, CAR T-cell therapy, or radiation, plus treatment of oral complications from head and neck cancer
- Kidney dialysis: dental exams and infection treatment before and during dialysis for end-stage renal disease
- Jaw fractures: stabilizing or immobilizing teeth as part of fracture treatment
- Tumor removal: dental ridge reconstruction done at the same time as tumor surgery
Outside of these specific medical scenarios, original Medicare pays nothing for cleanings, fillings, crowns, dentures, extractions, or any other routine dental work.
What Seniors Actually Pay
The financial burden is substantial. Average out-of-pocket dental spending for Medicare beneficiaries runs about $657 per year across all enrollees, but that figure is dragged down by the nearly half of beneficiaries who skip dental care entirely. Among those who do see a dentist, out-of-pocket costs average $1,615 a year.
Income makes a dramatic difference. Beneficiaries living below the federal poverty level spend an average of $255 on dental care annually, not because their teeth need less work, but because they can’t afford more. Those earning above 400% of the poverty level spend $1,095 on average. The gap reflects deferred care, not fewer dental problems. Low-income seniors are more likely to lose teeth, develop infections, and end up in emergency rooms for preventable oral health crises.
Roughly 80% of total dental spending for Medicare beneficiaries comes directly out of pocket, regardless of whether they’re in traditional Medicare or Medicare Advantage. That’s a strikingly high share compared to most other categories of health care.
Medicare Advantage and Supplemental Plans
Medicare Advantage plans (the private insurance alternative to original Medicare) frequently advertise dental benefits, and about 87% of plans do include some form of dental coverage. But the details matter. Only about 8% of Medicare Advantage plans offer what qualifies as a comprehensive dental benefit, meaning coverage with an annual maximum of $1,500 or more that includes major services like crowns, root canals, and dentures.
The rest typically cover preventive care (cleanings, X-rays, basic exams) with tight annual dollar caps that can run out quickly if you need anything beyond a routine visit. A single crown can cost $1,000 or more, which may exceed the entire annual dental allowance on many plans.
Medigap policies, the supplemental plans designed to fill gaps in original Medicare, don’t help here either. Because Medigap follows original Medicare’s rules, these plans generally don’t cover vision or dental care at all. If you want dental coverage alongside original Medicare, you’d need to buy a separate standalone dental insurance plan.
How Medicaid Differs
Medicaid, the program for people with lower incomes, takes a different approach. States are required to provide dental benefits for children enrolled in Medicaid and CHIP, but adult dental coverage is optional, and states set their own rules about what they’ll cover. Some states offer comprehensive adult dental benefits, others cover only emergency extractions, and a few provide almost nothing. Seniors who qualify for both Medicare and Medicaid (known as “dual eligibles”) may get dental coverage through their state Medicaid program, but the scope varies widely depending on where they live.
Efforts to Change the Law
There have been repeated attempts to add dental coverage to Medicare. The most recent is the Medicare Dental, Hearing, and Vision Expansion Act of 2025, introduced in the Senate, which would amend the Social Security Act to add “dental and oral health services” as a covered benefit under Medicare Part B. Similar bills have been introduced in previous sessions of Congress but have not passed, largely because of the projected cost. The Urban Institute has modeled what a Part B dental benefit would look like, estimating significant federal spending but also meaningful reductions in out-of-pocket costs, particularly for low-income and minority beneficiaries who currently forgo care.
The core tension hasn’t changed since 1965: adding dental coverage would improve health outcomes for millions of seniors, but it would also add billions in annual spending to a program that already faces long-term funding pressures. Until that political math shifts, the original exclusion stands, and most Medicare beneficiaries continue paying for dental care on their own.