What Dental Services Do Medicare Advantage Plans Cover?

Medicare Advantage plans provide an alternative to Original Medicare, offering the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance) through private insurance companies. These plans often bundle additional benefits not typically covered by Original Medicare, such as prescription drug coverage, vision, hearing, and dental services. The inclusion of dental benefits distinguishes many Medicare Advantage plans, addressing a common gap in traditional Medicare coverage.

Dental Coverage in Medicare Advantage Plans

Original Medicare does not cover routine dental care, including most procedures like cleanings, fillings, or dentures. It only covers dental services when they are linked to a Medicare-covered medical procedure, such as a dental exam before an organ transplant or cardiac valve replacement. Medicare Advantage plans are offered by private insurers and provide at least the same benefits as Original Medicare.

Dental coverage is a common supplemental benefit offered by Medicare Advantage plans, with over 97% of plans providing some form of dental coverage in 2025. The specific dental benefits available vary significantly from one plan to another, depending on the plan’s design and the region it serves. Some plans may include dental coverage as part of the standard premium, while others might offer it as an optional add-on for an extra monthly premium.

Specific Dental Services Provided

Medicare Advantage plans categorize dental services into preventive and comprehensive care. Preventive dental care includes routine services like annual or bi-annual oral exams, cleanings, dental X-rays, and sometimes fluoride treatments. Many plans offer preventive services with no or low cost-sharing when utilizing in-network providers.

Beyond preventive care, Medicare Advantage plans may cover comprehensive dental services. This can include basic restorative procedures like fillings, extractions, and root canals. Some plans also cover complex treatments such as crowns, bridges, dentures (full or partial), periodontics, prosthodontics, and oral surgery. Coverage for these advanced procedures varies by plan, with some offering limited benefits or requiring higher cost-sharing.

How Dental Benefits Work

The financial structure of dental benefits within Medicare Advantage plans involves several components that determine a beneficiary’s out-of-pocket costs. Dental coverage might be included in the overall plan premium, or it could require an additional monthly premium, with about 10% of beneficiaries paying an extra premium for dental benefits. Plans may also have a deductible, which is an amount the beneficiary must pay for dental services before the plan begins to contribute to the costs.

Copayments and coinsurance are common cost-sharing mechanisms applied to dental services. Copayments are fixed amounts paid for specific services, such as a $0 or low copay for preventive cleanings. Coinsurance represents a percentage of the service cost, with 50% coinsurance common for more extensive procedures like fillings or root canals. Most Medicare Advantage dental plans have an annual maximum benefit, which is the total dollar amount the plan will pay for dental care within a calendar year. This annual maximum averages around $1,300, and once this limit is reached, the beneficiary is responsible for 100% of additional dental costs for that year.

Network restrictions are also part of how dental benefits operate within Medicare Advantage plans. Many plans operate with a network of approved dentists, and beneficiaries receive the highest level of coverage and lowest costs when they use in-network providers. Health Maintenance Organization (HMO) plans require beneficiaries to use providers within the plan’s network, often needing referrals for specialists. Preferred Provider Organization (PPO) plans offer more flexibility, allowing beneficiaries to see out-of-network dentists, though at a higher out-of-pocket cost.

Choosing a Medicare Advantage Plan with Dental

Selecting a Medicare Advantage plan that aligns with your dental needs requires careful evaluation. Begin by assessing your current and anticipated dental care requirements, considering whether you primarily need preventive care or if you expect more extensive procedures. This personal assessment helps determine the level of dental coverage necessary.

Utilize resources such as the Medicare.gov Plan Finder tool to compare plans available in your service area. This tool allows you to filter plans based on their dental benefits, helping you identify options that offer the services you require. Review the “Summary of Benefits” document for each prospective plan, as this document provides detailed information on covered dental services, cost-sharing amounts, annual maximums, and any network limitations.

Enrollment in Medicare Advantage plans, or changes to existing plans, occur during specific periods. The Annual Enrollment Period (AEP), running from October 15th to December 7th each year, allows individuals to join, switch, or drop Medicare Advantage plans. The Medicare Advantage Open Enrollment Period (MA OEP), from January 1st to March 31st, allows those already in a Medicare Advantage plan to switch to another MA plan or return to Original Medicare.

Using Your Plan’s Dental Benefits

Once enrolled in a Medicare Advantage plan with dental coverage, practical steps ensure effective utilization of your benefits. Begin by locating in-network dentists using the plan’s provider directory, often available on the insurer’s website or by contacting member services. Many plans, particularly HMOs, require using network providers for covered services.

When scheduling appointments, inform the dental office about your Medicare Advantage plan. Present your plan identification card upon arrival for your visit to ensure proper billing. The dental office submits claims directly to your plan. You will then receive an Explanation of Benefits (EOB) from your insurer detailing the services received, the amount covered by the plan, and any remaining balance you owe.

For extensive or complex dental procedures, such as crowns or oral surgery, pre-authorization from your plan may be required before treatment begins. This process involves the dentist submitting documentation to the plan to confirm medical necessity and coverage, helping to avoid unexpected out-of-pocket costs. Always confirm any pre-authorization requirements with your plan or dental provider before undergoing significant treatments.