Medicare Dental Advantage Plans

Medicare Advantage Plans are organized and run by private insurance companies. Also known as Medicare Part C, Advantage Plans include extra types of coverage that is not included in Original Medicare. One of these advantages is dental coverage.

What is covered under a Dental Advantage Plan?

Not all Advantage Plans include dental coverage. Those that do will often have dental coverage available for an additional premium fee. Because dental care is not covered under Medicare, the rules and standards that apply to dental coverage can vary a great deal. If dental coverage is essential, it is important to carefully compare several Advantage Plans so that you are able to get the plan that best suits your needs. Most dental Advantage Plans will cover preventative care, cleanings, oral hygienist consultations, x-rays, dental consultations, fillings and limited periodontal care. These basic services will be covered at a higher rate (meaning your out of pocket expenses are lower) than more complex or complicated dental services.

This second set of dental services is usually covered but at a reduced rate meaning the patient pays a greater portion of these larger bills. The types of services that are included in this second tier usually include: crowns and bridges, root canals, oral surgery, dentures and denture adjustments, implants and periodontal surgery.

How Do Dental Advantage Plans Work?

Advantage Plans are managed care plans that use preferred provider networks. Dentists are included within these networks. Generally a Medicare recipient will need to choose one dentist from the provider network and then that one dentist is in charge of all preventative care and all referrals to dental specialists. Patients who seek treatment outside the network without a referral from the primary dentist generally pay 100% of the care. This is one of the major drawbacks to Dental Advantage Plans. Unless the plan has a provision for a dental emergency, care received outside of the plan's providers will not be covered. This is an important consideration and something to investigate carefully if you travel a lot or live in two separate places during the course of the year.

Dental Advantage Plans include premiums, deductibles, co-payments and co-insurance. The rates for these will vary and it is common for the premium to be bundled together into the same bill as the rest of the patient's insurance. The premium rates for Dental Advantage Plans are generally lower than outside stand alone dental plans.