How to Receive Dental Coverage with Medicare

Dentist performing procedure on senior man

While Medicare coverage generally covers most any issue with your body, it doesn’t include provisions for caring for your teeth beyond covering emergency or complex dental services. This means you typically have to pay costs for routine dental procedures, including extractions, fillings, cleanings, and dentures, out of your own pocket if you only carry original Part A and B Medicare coverage. Fortunately, Medicare Advantage plans can fill the gap with dental coverage for issues Medicare just doesn’t handle.

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Medicare Advantage Basics

Medicare Advantage plans offer a versatile alternative to Medicare Part A hospital insurance and Part B medical insurance. Also known as Medicare Part C or MA, these plans, provided by trusted private insurers such as Humana, Aetna, and Cigna, provide the same basic coverage as Medicare plus additional coverage chosen by plan customers.

Because some of these plans operate as a private fee for service (PFFS) plans, they usually have diverse regulations and guidelines that go beyond average Medicare Advantage plans so you can better match them to your health challenges and general lifestyle.

Medicare Advantage Plans with Dental Coverage

Since private insurance companies provide Medicare Advantage plans, their coverage options typically vary to give individual customers flexibility in their selections. All these plans cover everything Original Medicare covers, and most sell additional coverage, including dental plans that cover routine care. To be sure you choose Medicare Advantage plans with dental coverage, be sure to go over the plan thoroughly before making a commitment, as some private insurers list “Medicare-covered benefits” that don’t include dental.

Keep in mind that even with dental coverage, many plans require a co-pay, so you still have to pay some of your bills out of pocket for visits that aren’t routine care such as cleanings and X-rays.

Dental Procedures Covered by Medicare Advantage

Senior woman with Medicare Advantage dental care

Medicare Advantage plans that go above and beyond Original Medicare for dental procedures generally cover both emergency and routine services. Oral exams, dental X-rays, diagnostic services, and cleanings are covered in almost every supplemental insurance plan, and most also include restorative services such as fillings, root canals, and treatment of oral inflammation and gum disease. Other usually covered services include extractions, crowns, implants, bridges, and dentures.

Be aware when you purchase a Medicare Advantage plan that many limit dental coverage to a set number of procedures in specific time spans. For example, many only cover one cleaning or X-ray set every six months, and some only pay for a single extraction annually. If you have more complex dental needs, you may wish to contact insurers directly with questions and concerns before you purchase a dental plan from Medicare Advantage.

Costs for Dental Coverage with Medicare Advantage

When you sign up for a Medicare Advantage plan, you still pay the same premium as you pay now for Medicare Part B. Some MA plans have $0 monthly premiums beyond this, but most require co-payments at different percentages of your care bills. If you have Medicare Advantage dental coverage with coinsurance, you usually pay some percentage of the final bill, with the insurer covering the rest.

For example, if you incur $100 in costs for fillings or extractions and have 50% coinsurance, you end up owing $50 on the bill. Likewise, some plans utilize a co-payment system that requires you to pay a set amount per service rather than a percentage. This means if your bill equals $300 and you have a $50 co-pay, you only have to pay the $50.

Know that Medicare Advantage plans may have a cap on payment benefits per year. For instance, your insurer may only cover up to $1,000 of dental care per year, leaving you on the hook for the rest if you’re not careful. Many Medicare Advantage plans, however, may help you save lots of money in the long run.

Original Medicare doesn’t have a maximum out-of-pocket cap on benefits, but Medicare Advantage plans generally cap the maximum amount you have to pay, which can help you potentially preserve your nest egg.

Other Medicare Advantage Benefits

In addition to medical, hospital, and potentially dental benefits, Medicare Advantage provides a whole host of advantages. For instance, MA and Medicare Part C plans often cover routine vision checks, eyeglasses, and contacts, and many also provide coverage for routine hearing tests and hearing aids. Plans with provisions for prescription drugs can decrease your out-of-pocket drug expenses as well.

While Original Medicare helps seniors out with the big stuff, Medicare Advantage plans fill in the gaps where standard coverage falls short. Peruse our Medicare Advantage plans today to find the coverage you need at a price you can afford.

Find a Medicare Advantage Plan

If you’re interested in further researching Medicare Advantage plans available to you, use our free tool to compare qualifying plans. Any questions? Contact us directly at 1-888-225-1609.