Dental care is important for your health as you get older. Many people choose Medicare Advantage (MA) plans because these plans may include dental coverage. These Medicare plans can help you stay on top of your oral health.
What do I need to know about Medicare Advantage dental benefits?
Medicare Advantage plans may include dental benefits that go beyond Original Medicare coverage. Some plans help cover preventive dental care, comprehensive dental services and optional supplemental dental benefits. Reviewing plan details can help you understand what the covered dental services, provider options and potential out-of-pocket costs are.
What dental benefits do Medicare Advantage plans offer?
Some plans may include preventive dental care, like:
- Cleanings
- Oral exams
- X-rays
Some plans may also cover comprehensive dental services, such as:
- Fillings
- Extractions
- Crowns
- Periodontal maintenance
Optional Supplemental Benefits (OSB)
A dental Optional Supplemental Benefit (OSB) is extra dental coverage. Some Medicare Advantage plans let you add an OSB to get more dental services. A dental OSB can help cover more services like:
- Fillings
- Crowns
- Dentures
When can I add a dental OSB?
You can usually add a dental OSB:
- When you first enroll in your plan
- Within 30 days of your plan's start date or renewal date
- During the Annual Enrollment Period, Open Enrollment Period, or Special Enrollment Period
- To add a dental OSB, you can call the Member Services number. You can find this number on your Aetna® member ID card.
Does it cost extra?
- Yes. You'll pay an additional monthly premium for a dental OSB.
- Benefits, costs, and availability vary by plan.
Dental coverage with Medicare Advantage (MA) plans
Many MA plans include dental coverage.
| Benefit | Coverage |
|---|---|
| Oral exams | Often covered |
| Routine cleanings | Often covered |
| X-rays | Often covered |
| Fillings | Varies by plan |
| Extractions | Varies by plan |
| Teeth whitening | Teeth whitening is a cosmetic service. It's often not covered. |
Understanding your dental network
While many Medicare Advantage plans include a network dental benefit, dental network coverage can vary by plan type, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and HMO Point-of-Service (HMO-POS) plans.
- Your plan may cover certain dental services right away.
- Many HMO plans only cover care from dentists in your plan's network.
- PPO and HMO-POS plans may let you see any licensed dentist in the U.S. for care.
- Staying in network usually helps you save money even if out-of-network dental care is covered.
You can find an in-network dentist through the plan’s provider directory.
Preventive care
Most Medicare Advantage plans cover preventive dental services, like:
- Cleanings
- Exams
- X-rays
If you use a network dentist for preventive care, you may pay nothing out of pocket for these services.
Dental care for more complex things
Dental coverage for more involved care may change by plan. This includes:
- Fillings
- Extractions
- Crowns
You may need to pay part of the cost. To pay the lowest amount, see a dentist in the network. Check your plan to learn more.
Plan limits to know
As you review Medicare dental coverage, keep in mind:
- Your plan may set a limit on how often you get covered services. For example, it may pay for two cleanings each year.
- Your plan may have a set amount it pays each year (allowance). This is the most it will pay for your covered dental care.
- Not all plans cover comprehensive dental care. For example, some may not cover fillings or crowns.
Some Medicare plans don’t include full dental coverage. You can check your plan’s Evidence of Coverage to learn more.
Dental care and your overall health
As you get older, taking care of your teeth is an important part of caring for your whole body. With Medicare Advantage plans, you have options that may help make dental coverage easier and more affordable.
Commonly asked questions about Medicare Advantage dental coverage
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Medicare Advantage plans may include preventive dental benefits such as routine cleanings, oral exams and X-rays. Using an in-network dentist may help lower your out-of-pocket costs for covered preventive services. Covered dental services can vary by plan.
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Some Medicare Advantage plans already include preventive dental coverage. Certain plans may also include coverage for more comprehensive dental services. Reviewing plan details can help you decide whether you need additional dental coverage.
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Medicare Advantage dental coverage may include preventive services such as cleanings, exams and X-rays. Some plans may also help cover fillings, extractions, crowns and other comprehensive dental services. Coverage, copays and yearly limits can vary by plan.
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Some Medicare Advantage plans help cover major dental services such as crowns, root canals and other restorative dental care. Your costs can depend on the specific service, your plan coverage and whether you use an in-network dentist.
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Some Medicare Advantage plans include yearly limits for certain dental services. Limits can vary based on the type of dental care and the plan you choose. Reviewing plans can help you understand dental benefits, coverage limits and potential out-of-pocket costs.
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Medicare Advantage plans may combine medical, prescription drug and dental coverage into one plan. Standalone dental plans may offer different provider networks, coverage limits or premiums. Comparing costs, covered services and provider access can help you choose the dental coverage that fits your needs and budget.
