The Problems with Medicare Advantage Dental Insurance

Medicare and Dental Coverage

Original Medicare Parts A and B does not include traditional dental coverage so services such as routine cleanings, x-rays, fillings, extractions, and more advanced care are not reimbursed. Medicare Part A does cover some dental care that is “directly related to certain covered medical treatments,” particularly in cases where a covered dental service “linked to the success of the medical treatment.”1

Medicare Advantage plans, however, frequently add dental benefits not offered by Part A and Part B. A study of 6333 Medicare Advantage plans offered in 2023 found dental benefits were included in almost 90 percent of these plans.2 The Kaiser Family Foundation’s own review of Medicare Advantage plans reported that 97 percent of individual 2024 Medicare Advantage plans offered dental coverage.3 However, as the information below demonstrates, Medicare Advantage dental coverage does not seem to be a fit for every senior’s needs.

What Services Are Covered in Medicare Advantage Dental Benefits?

The degree to which dental benefits are covered in Medicare Advantage is not standardized, with coverage in plans ranging from restrictive to comprehensive.4 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.5 Surprisingly, the presence of an additional premium for dental coverage was associated with lower coverage of services like diagnostics and endodontics as compared to zero-premium dental benefits.6 It should also be noted that, just as the coverage of dental procedures is not standardized among Medicare Advantage plans, the out-of-pocket costs for covered procedures are not standardized either.

A study examining how differing levels of benefits affected the use of dental coverage observed "that restrictive characteristics of Medicare Advantage dental plans are associated with greater unmet dental need and financial barriers to care."7 A different study noted that their “findings suggest that MA beneficiaries delay dental care due to cost at higher rates and do not have rates of preventive dental use, suggesting that low use may not be exclusively associated with restricting low-value services but with, eg, restrictive networks, high OOP costs, or lack of awareness of benefits.” The acronym OOP means “out-of-pocket” costs here.

Given the many health reasons to avoid unmet dental needs, it is critical that seniors make wise decisions regarding Medicare Advantage dental benefits.

Why Is Oral Health Particularly Important to Seniors?

While oral health is not a trivial concern for any age group, seniors have especially significant concerns related to the subject. Seniors’ teeth, given a lifetime of use, may be more vulnerable to problems such as breakage or loss. Additionally, crowns that have reached 15 or 20 years of use may need future replacement. One more consideration is the increased chance seniors have of “dry mouth.” Dry mouth reduces saliva and exposes teeth to a higher risk of tooth decay. This condition can be caused by several prescription medications and people as they reach their senior years are more likely to use prescription medications.

Senior nutrition is also linked to dental health. Poor oral health in a senior can lead to tooth loss and, as a consequence, negatively affect what foods a senior citizen eats. Such a diet effect can, in turn, lead to a nutritional deficiency that has detrimental effects on other dimensions of physical health.

Should Seniors Consider Private Dental Insurance

Given the value of dental health, it is advisable for seniors to obtain quality dental coverage. For those in Original Medicare Parts A and B, there are private dental plans whose prices and covered services can be compared online at sites like this one. For those in Medicare Advantage insurance with dental benefits, it is wise to review what dental procedures are covered by the Medicare Advantage plan and determine if there are coverage gaps that need to be filled by a supplemental private plan. Additionally, it is also worthwhile for these Medicare Advantage enrollees to contact their dentists to confirm the acceptance of the plan’s dental benefits.

As mentioned earlier, privately purchased dental insurance is an option for seniors to consider. While private dental insurance is not the solution for every seniors need, it is worthwhile noting that data from 2022 comparing dental habits between seniors with private dental plans and those who had Medicare Advantage (MA) dental benefits observed “the percentage of seniors with a MA dental benefit that visited a dentist was 55% in 2022. Among seniors with private dental insurance outside of Medicare Advantage, the percent that visited a dentist was 77% in 2022.”8

SOURCES

¹ Medicare.Gov, "Dental Services,"
² Lisa Simon et al. "Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County," JAMA, December 26, 2024,
³ Meredith Freed et al, "Medicare Advantage 2024 Spotlight: First Look," KFF, November 15, 2023,
⁴ Kamyar Nasseh et al, "Benefit Design and Access to Dental Care Among Seniors With Medicare Advantage Dental Benefits," JAMA, January 24, 2025,
⁵ Joanne Fontana et al, "Dental coverage in Medicare Advantage plans: Nationwide market landscape, 2024 update," Milliman, September 10, 2024,
⁶ Ibid.
⁷ Nasseh, "Benefit Design and Access to Dental Care Among Seniors With Medicare Advantage Dental Benefits."
⁸ Health Policy Institute, "National Trends in Dental Care Use, Dental Insurance Coverage, and Cost Barriers," ADA, September 2024,