If you’re new to the world of , you’ll soon discover that original Medicare (Part A and Part B) . Nor do many , though some may. (Medigap is extra insurance that you can purchase from a private health insurance company to help pay for out-of-pocket costs that you’ll incur with original Medicare.)
Dental coverage is part of the appeal of getting a , known as Part C. Many Medicare Advantage plans offer dental coverage and are quick to promote that. Still, other Medicare recipients opt to buy a separate dental plan to cover their needs.
Most seniors, however, have been leaning toward choosing Medicare Advantage plans in recent years, says Whitney Stidom, vice president of sales enablement with eHealth, a health insurance broker and online resource provider headquartered in Santa Clara, California.
“Medicare Advantage plans are popular today, with over half of all Medicare beneficiaries enrolled, but benefits can vary quite a bit from one plan to another,” Stidom says. “I wouldn’t recommend beneficiaries enroll in Medicare Advantage solely because they want dental benefits. However, if they find that Medicare Advantage is the best option for their overall health care needs and budget, it is a good idea to look for one that also includes dental coverage.”
So, if you’re looking for some sort of dental care, here’s what you need to be thinking about.
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Is Dental Coverage Worth It?
Yes. It doesn’t really matter if your teeth look like you were on the losing end of a boxing match, or if you flash a smile that belongs in a teeth whitening commercial — either way, it’s hard to argue that you shouldn’t have dental coverage. Poor oral health has been connected to everything from diabetes to cardiovascular disease, strokes, , and even cancer.
So if you want to , you’re going to have to find a stand-alone dental insurance plan or a Medicare Advantage plan.
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Call a Medicare Broker or Agent, SHIP and Your Dentist
While talking to a can do wonders in terms of finding a Medicare Advantage plan that offers dental coverage, if you currently have a dentist, ask the office manager what plan they would recommend. You should quickly get an earful on which Medicare Advantage plans work well in the office and which don’t, due to .
Still, if you call a Medicare broker or agent, they can also recommend a variety of Medicare Advantage plans and, if you tell them what you’re looking for, hopefully steer you to a good one.
In addition, use resources like a to compare options and find the best fit. is a volunteer-staffed free helpline for seniors, their families and who need help with Medicare questions and problems.
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Assess Your Dental Needs
Before you talk to a Medicare Advantage broker or agent — or sift through Medicare Advantage plans and do the research yourself — you really should think about what you want out of dental insurance coverage, so you know what you want to look for. There are a number of criteria you may be particularly interested in:
— $0 premiums. If money is an issue, finding a plan with $0 premiums may be a top priority. Just remember that some Medicare Advantage plans with higher may be more affordable in the long run. “It’s important to look at deductibles, copays, coinsurance and annual maximums, rather than only the premium,” Stidom says. “A lower premium plan might cost more overall if it has high out-of-pocket expenses when you need dental care.”
— High annual benefit limits. The annual benefit limit is the most an insurance company will pay for your treatment within a year. So if you’re worried you may be in for a considerable amount of dental expenses, way beyond what an insurer will pay for an annual exam and some X-rays, you might want to prioritize this instead of, for instance, $0 premiums.
— Coinsurance. This is the portion of your insurance that you’ll pay after you meet your deductible. You’re sharing the cost of the dental work at that point, and if, for instance, your insurance is going to pay 20% of a root canal, you still are responsible for 80%. If that makes you uncomfortable, you may want to prioritize what you pay for coinsurance rather than focusing on the annual benefit limits or the size of your premium. Really, as Stidom says, you want to look at the entire picture and probably aim for a healthy balance when it comes to determining how much you should pay for dental coverage.
— Availability. Your dental coverage doesn’t do you much good if your isn’t in your plan’s network. Remember to call your dentist and ask if they take the dental plan you’re considering. You may still be able to see your dentist if they’re not in-network, but you may need to pay a higher coinsurance and you may be balanced billed (meaning you may need to pay the difference between what the dentist charged and what your insurance was willing to pay).
— Comprehensive or basic. Some Medicare Advantage plans only offer preventive help, paying for annual exams and X-rays. That certainly can help with your budget, and you may feel like that’s all you want covered and you’ll take care of the rest if you have cavities or other issues. However, if you do have a track record of tooth decay or believe fillings, , crowns, and gum disease could be in your future, you probably will want to consider getting a plan that offers comprehensive care.
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Pay Attention to the Details
It isn’t hard to find a Medicare Advantage plan that covers oral health.
“It seems like every Medicare Advantage plan is now offering some sort of dental benefit,” says Mara Woloshin, an insurance broker, certified retirement coach and consultant based out of Portland, Oregon.
But it is hard to find a Medicare Advantage plan that generously pays for everything beyond cleanings and basic treatment.
“While most plans are sticking to preventative dental, some plans have capped limits and are combining comprehensive and preventative dental under one cap, like $1,000 total,” Woloshin says.
Stidom adds that “it’s important for beneficiaries to understand that dental insurance works differently than health insurance. It’s not open-ended coverage. Dental plans provide specific, defined benefits on a specific calendar-year basis, including for preventive cleanings, fillings and crowns, root canals and more. Some dental plans have waiting periods, requiring enrollees to pay their premiums for a certain number of months before services are covered.”
It’s also worth noting that if your health is poor, you may be able to find more dental coverage than you might imagine in a Medicare Advantage plan.
“The really good news for those who may have diabetes or heart disease are Medicare Advantage chronic ,” Woloshin says. “For a modest premium, like $26 monthly, this group of beneficiaries can enjoy as much as $3,500 for dental and $0 for any and all .”
She adds that these plans require a diagnosis verification from an attending physician.
Bottom Line
If you are getting Medicare or already have it, and you want your dental work to be paid for, you can certainly find good coverage. But in the spirit of the dentist’s office, you may have to do a lot of drilling into the details before you find one you’re satisfied with.
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Update 01/06/26: This story was published at an earlier date and has been updated with new information.
