Jesse Smedley is a Principal of Oakbridge Insurance and the founder of iHealthBrokers. He founded iHealthBrokers in 2007, and Oakbridge acquired iHealthBrokers in 2025. He has spent nearly two decades teaching people how to save money on their health insurance and navigate Medicare, and he is the author of Medicare A to Z: Your Roadmap to Medicare.
It may surprise you that Original Medicare doesn’t cover routine dental care. That includes cleanings, fillings and dentures. Medicare only pays for dental services in limited cases tied to other covered medical treatment. So for everyday dental care, the day you turn 65, you’re on your own.
Many dental plans are built so the math barely works in your favor unless you know what to look for. Before you buy one, it helps to understand how dental insurance actually works, what to check, and when you may be better off not buying a plan at all.
Your Three Main Options for Dental Coverage on Medicare
Since Original Medicare doesn’t cover routine dental, you have three main options:
- A Medicare Advantage plan that includes dental coverage
- A stand-alone dental insurance plan
- No dental insurance, possibly using a dental savings plan instead
Here’s what each one looks like.
Option 1: Medicare Advantage Dental Coverage
Many Medicare Advantage plans include some dental coverage. But don’t make your decision based on that alone. If you’re weighing Original Medicare against Medicare Advantage, dental shouldn’t be the deciding factor. It’s a fringe benefit.
The dental coverage in a Medicare Advantage plan is often fairly limited, so it shouldn’t drive such an important decision.
Option 2: Stand-Alone Dental Insurance
You can buy a private stand-alone dental plan whether you have Original Medicare or Medicare Advantage. Even if your Medicare Advantage plan includes dental, you can add a private plan for extra coverage.
Before you worry about another monthly premium, know that dental premiums are much lower than health insurance premiums, and there are plenty of inexpensive plans. See your options on our dental and vision insurance page.
Does that mean you should pick the cheapest one? Not necessarily. It depends on your needs, and with dental plans, you also have to consider networks.
Option 3: Dental Savings Plans and Discount Plans
There are also dental savings plans, sometimes called dental discount plans. Some dentists offer their own, and others accept an outside plan. This isn’t insurance. You pay a membership fee and get discounted prices on services.
This can be a great way to save money if you’re flexible about which dentist you see, or if your current dentist offers or accepts one of these plans.
What to Compare When Choosing a Dental Plan
When you compare your options, look at a few key factors.
Monthly Premiums
The premium is the easiest thing to compare.
With a Medicare Advantage plan, dental is built into the plan. A dental savings or discount plan usually costs just a few dollars a month. Private insurance will likely cost a bit more, but there are so many plans to choose from that you have a lot of flexibility.
Dental Networks: DHMO vs. PPO
You also need to compare networks. There are two main types of dental plans, and they work much like their health insurance counterparts.
A DHMO is the dental version of an HMO. You must use in-network dentists, but these plans usually cost less than a PPO.
A dental PPO gives you more choice of dentists. You can go out of network, but staying in network costs less. If you need more flexibility in choosing a dentist, a PPO is likely the way to go. A DHMO is more restrictive.
Because DHMOs pay dentists differently than PPOs, some people say they feel rushed at their DHMO dentist. That isn’t always the case, and many people love their in-network dentists. But it’s worth knowing. If you have more extensive dental needs or dental anxiety, you’ll probably want more comprehensive coverage and more flexibility.
To sum up: private insurance gives you the most flexibility because there are more plans to choose from. With Medicare Advantage, you’re largely limited to that plan’s dental terms. A dental savings plan narrows your choices further, but it can still be a good way to save if it works for you.
How Dental Insurance Coverage Actually Works
So what happens when you actually use your plan?
DHMO vs. PPO Costs
DHMOs are easier to understand because they usually have set prices for each service, listed in your plan.
Dental PPOs often use what’s called a 100/80/50 structure:
- Preventive care is covered at 100%, so you pay nothing.
- Basic services, like getting a cavity filled, are covered at 80%, so you pay 20%.
- Major work is split 50/50.
The tricky part is that dentists charge different rates, so 50% at one dentist may not equal 50% at another. And it’s only 50% of what your plan allows.
Also check whether your plan has a deductible.
Annual Maximums: The Big Drawback of Dental Insurance
Dental insurance also has an annual maximum, and that’s its biggest drawback.
Whether your dental coverage comes with a Medicare Advantage plan or a stand-alone plan, there’s almost always a yearly limit. Once you reach it, you pay the rest of your bills for the plan year.
In our experience, many plans cap out somewhere around $1,000 to $1,500 a year. If you’ve ever needed extensive dental work, you know that won’t go far, and you could end up with big bills.
Dental savings plans work differently. If you can be flexible, you may save more with that option.
Some plans do offer higher annual maximums. If you know you’ll need major work, pay close attention to the annual maximum and choose a plan with a higher limit.
Waiting Periods for Major Dental Work
Many new plans have waiting periods for major services. If you’re signing up for a new plan because you need a root canal, you may have to wait before it’s covered.
Other Dental Insurance Details You Should Know
Beyond the numbers, check whether your dentist is in network and look closely at any waiting periods.
The Missing Tooth Clause
Many plans also have a missing tooth clause. If a tooth was already missing before you joined the new plan, the plan may not cover replacing it, because the problem existed before your coverage started. It’s similar to a pre-existing condition in health insurance.
If you need treatment for a missing tooth, you may want to take care of it before you switch plans.
Is Medicare Advantage Dental Coverage Enough?
If you’re in a Medicare Advantage plan with dental coverage, look closely at the terms, because the coverage is often modest at best.
Even with that coverage in place, you may want a dental savings plan or private dental insurance as well to make sure you’re adequately covered. It all comes down to your budget and your needs.
Medicare won’t cover the routine stuff. Dental plans live and die by their annual maximums. And whether you need a plan at all depends on your dental needs. For more, read Best Dental Insurance for Seniors and Don’t Waste Money on Dental Insurance!
Get Help Finding a Dental Plan
Our licensed brokers can compare dental plans in your area and help you find one that fits your needs and budget, at no cost to you. Get your free quotes or call us at (866) 260-9829.
