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Understanding Medicare Advantage dental coverage

Color portrait of Sachi Fujimori By Sachi Fujimori

Dental care is a vital part of maintaining your health and well-being, especially as you age. And one of the main perks of joining a Medicare Advantage (MA) plan is that many plans offer dental coverage to help you keep up with your oral health.

Original Medicare, on the other hand, does not cover routine dental care, such as cleanings, X-rays, and fillings. Due to the relatively high out-of-pocket costs for these procedures, some older adults end up forgoing necessary dental care. There is one exception, however: If you need medical dental procedures while you’re in the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance).  

Dental benefits are already included in the majority of Aetna MA plans. For some Aetna MA plans that don’t include dental coverage, you may have the choice of paying extra each month for dental benefits. This is done through an optional supplemental benefit. 

To learn more about using your Aetna MA dental benefits, read our guide below. 

Aetna MA plans

Aetna MA plans offer three types of dental coverage:

Network

Included in some health plans.

For HMO plans, you must see a dental care provider within the network of approved providers.

For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network.

Preventive services (cleaning, x-rays, exams, etc.) are covered at 100% on most plans.

Some plans cover comprehensive services. See your Evidence of Coverage for details.

You may have an annual plan maximum.

 

Direct member reimbursement allowance

Included in some health plans.

No network requirements.

You pay up front for dental care and submit receipts for reimbursement.

You’re given an annual “allowance” to spend on dental care.

 

Optional supplemental benefits (OSB)

If your plan doesn’t include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan).

For HMO plans, you must see a dental care provider within the network of approved providers.

For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network.

Aetna MA plans

Aetna MA plans offer three types of dental coverage:

Network

Included in some health plans.

For HMO plans, you must see a dental care provider within the network of approved providers.

For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network.

Preventive services (cleaning, x-rays, exams, etc.) are covered at 100% on most plans.

Some plans cover comprehensive services. See your Evidence of Coverage for details.

You may have an annual plan maximum.

 

Direct member reimbursement allowance

Included in some health plans.

No network requirements.

You pay up front for dental care and submit receipts for reimbursement.

You’re given an annual “allowance” to spend on dental care.

 

Optional supplemental benefits (OSB)

If your plan doesn’t include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan).

For HMO plans, you must see a dental care provider within the network of approved providers.

For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network.

Aetna MA plans offer three types of dental benefits: network, direct member reimbursement allowance and optional supplemental benefits.

Medicare Advantage dental plans

What’s covered under Medicare Advantage dental plans

Some of the covered dental services may include (be sure to check with your plan for details):

  • Oral exams
  • Cleanings
  • X-rays
  • Fillings
  • Root canal treatments
  • Tooth extractions
  • Crowns, bridges and implants
  • Dentures

If you have network or OSB coverage, you may be limited to a specific number of services per year. You may also be required to pay a portion of the costs. Check your Evidence of Coverage (EOC) for more details.

 Medicare Advantage dental plans

What’s covered under Medicare Advantage dental plans

Some of the covered dental services may include (be sure to check with your plan for details):

  • Oral exams
  • Cleanings
  • X-rays
  • Fillings
  • Root canal treatments
  • Tooth extractions
  • Crowns, bridges and implants
  • Dentures

If you have network or OSB coverage, you may be limited to a specific number of services per year. You may also be required to pay a portion of the costs. Check your Evidence of Coverage (EOC) for more details.

Network

With Medicare Advantage plans that include a network dental benefit, you’re covered up front for specified dental services but may be required to see a dentist within your network of providers. Some preferred provider organization (PPO) and health maintenance organization point-of-service (HMO-POS) plans, however, do allow you to see any licensed dental provider, but you may save money by seeing a provider in our network. You can find a network provider by logging in as a member and going to our provider directory.

Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans.  This means you pay nothing out of pocket if you stay in network. For comprehensive services, such as fillings, extractions and crowns, the coverage varies according to plan, and you may have to pay a portion of the cost of services. Check with your plan for more details. 

As you plan for your dental care, keep in mind that you may have limits on the amount of preventive care visits you can make each year, as well as caps on coverage for comprehensive services. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. This benefit maximum can range from about $150 to $6,000.   

Direct member reimbursement allowance 

With Aetna MA plans that include a direct member reimbursement (DMR) allowance, members are given a set amount of money to spend each year on dental care.  You’ll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna® for reimbursement.

“With a direct member reimbursement allowance, you’re given a set amount of money to spend each year on dental care.”

You can see any licensed dental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments).

One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance.

Direct member reimbursement allowance: How to get reimbursed for dental care

  1. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided.
  2. Print and fill out the reimbursement form. Or log in to your member account to submit the form online.
  3. Send the form with the receipt to the claims address found on your member ID card. Be sure to make copies of all of your paperwork. If you’re submitting your form online, be sure to attach your receipt to your submission.
  4. If you’re unable to print out the form, you can write out all the required information on a piece of paper and send it with your receipts.
  5. Claims must be submitted within 365 days of the date you received the service.
  6. Allow approximately 4-6 weeks for reimbursement.
Reimbursement for dental care

Direct member reimbursement allowance: How to get reimbursed for dental care

  1. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided.
  2. Print and fill out the reimbursement form. Or log in to your member account to submit the form online.
  3. Send the form with the receipt to the claims address found on your member ID card. Be sure to make copies of all of your paperwork. If you’re submitting your form online, be sure to attach your receipt to your submission.
  4. If you’re unable to print out the form, you can write out all the required information on a piece of paper and send it with your receipts.
  5. Claims must be submitted within 365 days of the date you received the service.
  6. Allow approximately 4-6 weeks for reimbursement.

Optional supplemental benefits

If your MA plan doesn’t include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits for an additional monthly premium. Members must enroll in this option when they enroll in their plan, or within 30 days of their plan’s start date.

These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network.

As you age, maintaining your oral health is an important part of your whole-body wellness. And with Aetna MA plans, you have a variety of options to make it more affordable and easier to keep up with your dental care. 

About the author

Sachi Fujimori is a writer and editor based in Brooklyn who focuses on writing about science and health.  A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl.

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