Navigating Medicare’s Evolving Dental Coverage: What Dentists Need to Know
While traditional Medicare historically excludes most dental services, recent regulatory updates, as reported by KFF, have modestly expanded coverage for specific medically necessary procedures. Dentists need to be aware of these changes to better support patients undergoing treatments including organ transplants, cancer therapy, and dialysis.
Medicare’s approach to dental care has long been restrictive, offering little to no coverage for routine procedures like cleanings, fillings, and dentures. However, recent updates to the Medicare Physician Fee Schedule, spanning from 2023 to 2025, have introduced changes that modestly expand coverage for specific dental services deemed “medically necessary” in relation to certain medical treatments. KFF recently reported on these changes.
Medicare traditionally excludes payment for dental services unless they are integral to the success of certain medical treatments. The updates, introduced through final rules by the Centers for Medicare and Medicaid Services, clarify and broaden the definition of medically necessary dental services in specific clinical scenarios.
In 2023, exams and necessary treatment became covered before organ transplants, cardiac valve replacements, and valvuloplasty procedures. In 2024, Medicare started to pay for dental care addressing complications arising from radiation, chemotherapy, or surgery in head and neck cancer treatments. Coverage is also extended to dental evaluations and care preceding chemotherapy, chimeric antigen receptor T-cell therapy, and treatments involving high-dose bone-modifying agents.
Beginning in 2025, dental exams and infection control measures will be covered prior to or during dialysis treatments for end-stage renal disease. These changes allow Medicare beneficiaries access to essential dental care when it directly impacts the success of broader medical treatments.
While these updates are promising, dentists should note that the changes represent a modest expansion rather than comprehensive dental coverage. Routine care, such as preventive exams and restorative work unrelated to broader medical conditions, remains excluded from Medicare reimbursement.
For dental services eligible for Medicare coverage, payment is typically processed through Medicare’s physician fee schedule. Dentists should be aware that payment rates for these services may vary based on determinations by regional Medicare Administrative Contractors.
Patient Guidance and Challenges
Despite these policy shifts, a significant portion of Medicare beneficiaries will continue to face high out-of-pocket costs for routine dental care. Cost remains a primary barrier to dental services. Nearly half of Medicare beneficiaries are enrolled in Medicare Advantage plans, which often include dental benefits, though the scope of coverage varies widely.
The modest expansions in Medicare’s dental coverage signal growing recognition of the connection between oral health and overall health. Advocacy for broader coverage continues, driven by patient advocates and healthcare providers. Click here to read more.
