5 Questions to Ask about Your Medicare Advantage Dental Benefits

Why Seniors Are Asking Questions about Medicare Advantage Dental Coverage

Most Medicare Advantage (MA) plans offer some form of dental coverage¹ but recent studies have raised questions about the consistency and quality of these dental benefits. Before discussing these issues with MA dental coverage, it is useful to review a few facts about Original Medicare. Original Medicare refers to Part A and Part B. Medicare Part A covers hospitalization services and Part B covers medical services. Original Medicare does not include traditional dental coverage, which means procedures such as routine preventive care (e.g., cleanings and x-rays), basic care (e.g., fillings and extractions), and major care (e.g., root canals, crowns, and implants) are not reimbursed by the Medicare program. Medicare Part A does have limited exceptions to this rule in cases where dental care is “directly related to certain covered medical treatments,” particularly in cases where a covered dental service “linked to the success of the medical treatment.”²

MA plans typically include supplemental benefits that extend beyond the coverage of Original Medicare, and it is in this context that most MA plans offer dental benefits. However, MA dental benefits are not standardized, with coverage in plans ranging from restrictive to comprehensive.³ Comprehensive coverage, in this context, meaning reimbursement for high-priced procedures like crowns and implants alongside lower-cost procedures like routine cleanings and fillings. In most cases, dental benefits are a standard feature of the Medicare Advantage plan but in some instances dental benefits are available for an additional premium, or there is an enhanced dental benefits option available for an additional premium.⁴

For more information, see our article “The Problems with Medicare Advantage Dental Insurance.”

Medicare Advantage Dental Benefits Questions

The below list of questions is a simple tool to help you evaluate the quality of your MA dental benefits. When evaluating your MA dental coverage, we recommend that you ask:

1. Does my MA plan describe its dental benefits within its Summary of Benefits document?
   1. Your insurance plan brochure may also provide some of this information.
   2. If you cannot find this information you should call your MA plan and request documentation describing all the plan’s dental benefits.
2. Does my dentist accept this MA coverage?
   1. You can usually go to the insurance company’s website to look up which providers accept its coverage.
   2. As an alternative, you can call your dentist and ask if the practice accepts your MA plan.
3. Is there a maximum benefit on my MA dental coverage?
   1. An annual maximum benefit is a dollar amount that represents the most an insurance plan will pay for your covered dental care within a year.
   2. If there is a maximum benefit, what is the limit that the MA plan will spend annually toward my dental care? For example, that limit may be as low as $500 or it might be over $1,000.
4. Are major dental procedures like crowns and implants covered by my MA dental coverage?
   1. Major dental procedures can cost more than several thousand dollars so their coverage is an important consideration when evaluating the quality of MA dental coverage.
   2. Watch for waiting periods that delay when coverage of an expensive procedure is available.
5. Does my MA dental coverage include more than general dentists?
   1. Local specialists such as oral surgeons, endodontist (who treat the tissues and nerves of the teeth), and periodontist (who treat the gums) are essential components of adequate dental coverage.

Shopping for Full Coverage Dental Insurance

If your evaluation leads you to address weaknesses in your MA plan’s dental benefits, you can purchase additional coverage. Websites like this one allow you to comparison shop dental plans available in your region. You can use the same questions from the MA evaluation to evaluate these dental insurance options (For more detailed guidance, see the article “How to Choose the Right Dental Insurance.”) The plan comparison process will ask you for some basic information such as your zip code and birthdate in order to display the plans available in your area as well as each plan’s correct monthly cost. Click this link to begin the process.

Examples of Comprehensive Dental Plans by State

Want a few examples of comprehensive dental insurance plans in your state? Visit our article “What Is Full Coverage Dental Insurance” and you’ll find a table at the bottom of the page that lists two dental comprehensive dental plans for most states (a few low-population states such as Alaska and South Dakota only have one example).

We also have articles focused on dental plans that cover crowns, implants, and other major dental work.

SOURCES

¹ Lisa Simon et al. Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County, JAMA, December 26, 2024,
² Medicare.Gov, "Dental Services,"
³ Kamyar Nasseh et al, "Benefit Design and Access to Dental Care Among Seniors With Medicare Advantage Dental Benefits," JAMA, January 24, 2025,
⁴ Joanne Fontana et al, "Dental coverage in Medicare Advantage plans: Nationwide market landscape, 2024 update," Milliman, September 10, 2024,