Millions of older Americans face a simple problem: Medicare does not cover routine dental care. About 24 million seniors are left to pay out of pocket for everything from cleanings to crowns and implants. For many, the cost is out of reach, so more people are heading abroad for dental work they can actually afford.
This gap in coverage is not new. When Medicare started in 1965, dental care was left out on purpose, mainly because of cost concerns and pushback from dental groups. Most retirees lose their work-based dental insurance, which rarely covers more than $1,000 a year-barely enough for a single crown, let alone bigger procedures.
In 2024, Medicare began covering only a narrow set of dental services directly tied to certain medical treatments, such as cancer care for the head and neck, but did not introduce a general dental benefit for all seniors.
Efforts to add dental coverage have stalled again and again. The Biden administration tried to include it in the Build Back Better bill in 2021, but the proposal was dropped over cost and reimbursement disputes. In 2022, Congress approved limited coverage for dental care linked to specific medical needs-like organ transplants or cancer treatment-but most seniors still get no help. As a Triage Cancer policy review notes, the 2024 update did not create a general Medicare dental benefit, so routine care remains uncovered for nearly everyone.
The effects of untreated dental problems are serious. Poor oral health can lead to infections, hospital stays, and even death. Former U.S. surgeon general C. Everett Koop once said, "You are not healthy without good oral health." That warning feels more urgent now, as wealthier seniors can pay for care while those with lower incomes often go without, deepening health gaps.
For people priced out of U.S. dental care, traveling abroad has become a practical option. Clinics like Prisma Dental in Costa Rica offer everything from fillings to full mouth restorations for much less than in the U.S. A $1,000 budget that might barely cover a cleaning and a filling at home can pay for several procedures in a modern overseas clinic. Most patients are not looking for cosmetic work-they need basic treatments that Medicare will not pay for.
The original design of Medicare in 1965 intentionally excluded routine dental, vision, and hearing services, focusing instead on hospital and physician care. This historical decision continues to shape the lack of dental coverage for seniors today.
- fedlaws.org, Healthcare Law Resource
Dental tourism also lets people avoid the patchwork of limited private dental plans and the uneven benefits in Medicare Advantage. In 2016, only a small share of traditional Medicare users bought separate dental plans, and while most Advantage enrollees had some dental coverage, the details varied a lot. The costs add up: one in five Medicare beneficiaries spends at least $1,000 a year on dental care, which hits hardest for those with the least money to spare. As a Medicare Advantage plan analysis explains, dental benefits in these plans are commercial add-ons and change by region and year, unlike the blanket exclusion in Original Medicare.
As more Americans look abroad for care, scams and misinformation have become a real risk. Authorities have warned about fake dental subsidy offers aimed at older adults, as reported earlier. Anyone considering dental tourism needs to check clinic reputations and credentials carefully.
Despite the clear link between oral health and overall health, Congress has not acted to close the gap. Until Medicare covers basic dental care, many Americans will keep traveling for treatment. Dental care is not a luxury, and the current system leaves millions behind. For now, clinics like Prisma Dental offer a workaround, but the real solution will have to come from policy, not plane tickets.
