Understanding Medicare Advantage dental coverage

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). For example, if you need tooth extractions for radiation treatment for jaw cancer, Medicare will cover those costs. 

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

Network

Under this type of plan, you’re covered up front for specified dental services but must see a dentist within your network of providers. Some preferred provider organization (PPO) plans, however, do allow you to see a dentist outside of the network, but these services will cost you more. 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.  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 will 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 have limits on the amount of preventive care visits you can do 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 $1,000 to $3,000.  

Direct member reimbursement allowance 

In the most common type of dental benefit included in Aetna MA plans, 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 to get reimbursed within four to six weeks.

You can see any licensed dental care provider that hasn’t opted out of Medicare. And since less than 1 percent of dentists have opted out of Medicare, chances are you can see your preferred dentist. 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. 

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 with 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 require you to choose a dental care 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. 

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.