Does Medicare Advantage Cover Dental? A Plain-English Answer

Medicare and dental coverage is one of the most confusing parts of the whole Medicare system -- and it trips up thousands of seniors every year. The short answer is: Original Medicare barely covers dental at all, but many Medicare Advantage plans do. Here is a plain-English breakdown of exactly what that means for you.

Why does Original Medicare not cover dental?

This surprises a lot of people. Original Medicare was designed in 1965 primarily to cover hospital stays and doctor visits. Dental care was considered separate and optional. So today, Medicare Part A and Part B cover dental services only in very narrow circumstances -- for example, if you need dental work directly related to a covered hospital procedure. Routine checkups, cleanings, fillings, dentures? Not covered under Original Medicare.

So what does Medicare Advantage cover for dental?

This is where it gets better. Medicare Advantage plans are offered by private insurance companies and are required to cover at least everything Original Medicare covers -- but most plans go further. A large majority of Medicare Advantage plans include some level of dental coverage. At minimum, this typically means two preventive cleanings per year, X-rays, and routine checkups. Many plans also cover basic services like fillings and extractions. More comprehensive plans may cover crowns, root canals, bridges, and even partial dentures. The key question is always: which plans are available at your specific zip code, and what exactly does each one cover for dental?

What about annual limits and networks?

Here is the catch many seniors do not find out about until after they enroll: most Medicare Advantage dental benefits come with an annual maximum -- the most the plan will pay for dental in a given year. This is often between $1,000 and $2,500. If you need major dental work, that limit can be reached quickly. There are also network restrictions -- you will typically need to see a dentist who participates in your plan's network. Some plans use PPO dental networks (more flexible, you can see any dentist), while others use HMO-style networks (you must use in-network dentists). A licensed agent can walk you through the specific dental network and limits for each plan before you commit.

How do I actually find a plan with good dental coverage?

The tricky part is that dental benefits vary enormously from plan to plan and from zip code to zip code. A plan in one county may have excellent dental coverage while a plan from the same company in another county has much weaker dental benefits. The fastest way to find the right answer for your situation is to call a licensed agent and give them your zip code. They can pull up every plan available in your area, show you the dental benefits side by side, and help you pick the one that fits your needs -- all at no cost to you.

Other questions we can help with

• How Much Does Medicare Advantage Actually Cost? No Jargon
• Medicare Advantage vs. Original Medicare: Which Is Right for You?
• When Can I Sign Up for Medicare Advantage? Enrollment Periods Explained Simply
• What Extra Benefits Does Medicare Advantage Include? The Full List