What senior dental plans actually cover

Senior dental plans fall into two main types: dental insurance (which you pay a monthly premium for) and dental discount plans (which charge an annual membership fee instead). Neither is the same as Medicare — Original Medicare does not cover dental care at all, though some Medicare Advantage plans include dental benefits.

Dental insurance typically covers preventive visits (cleanings, exams, X-rays) at 100 percent, basic work (fillings, extractions) at 70 to 80 percent, and major work (crowns, root canals, implants) at 50 percent. Discount plans work differently: you pay the membership fee upfront, then receive a set discount (usually 10 to 60 percent) off the dentist's regular price when you visit. You pay the dentist directly at the time of service.

Many seniors buy dental plans through their employer if they still work, through AARP, or directly from insurance companies. Others find plans through the Health Insurance Marketplace (Healthcare.gov). Some states offer Medicaid dental coverage for seniors who meet income limits — this varies widely by state.

Key Takeaways

  • Dental insurance and discount plans are separate from Medicare and work in different ways: insurance uses premiums and percentage coverage, while discount plans charge a membership fee and give you a percentage off the dentist's bill.
  • Preventive care (cleanings and exams) is usually covered at 100 percent by dental insurance, but major work like crowns or implants may only be covered at 50 percent.
  • Most dental plans have a waiting period of 6 to 12 months before they cover major work, so you cannot use them when ready for expensive procedures.
  • Medicaid covers dental care for some seniors, but coverage and income limits differ by state — contact your state Medicaid office to learn what is available where you live.
  • If you have a Medicare Advantage plan, check your plan documents to see whether dental is included, because coverage varies by plan and by region.

Dental insurance versus discount plans

Dental insurance requires you to pay a monthly premium (typically $10 to $30 for an individual) and then share the cost of care with the insurance company. You visit an in-network dentist, and the insurance pays its portion directly to the dentist. You pay your copay or coinsurance at the appointment. Dental insurance works best if you expect to need significant care, because the insurance company's negotiated rates with dentists are usually lower than what you would pay out of pocket.

Discount plans charge an annual membership fee (usually $80 to $200) and give you access to a network of dentists who have agreed to discount their fees. When you visit, you pay the discounted price directly to the dentist — there is no insurance company in the middle. Discount plans have no waiting periods and no annual maximums, so they work well if you want to avoid delays or if you need a lot of work done in one year. However, they do not protect you from catastrophic costs the way insurance does.

A third option is to pay out of pocket at a dentist who offers a cash discount or a payment plan. Some dentists reduce their fees by 10 to 20 percent if you pay in full at the time of service, or they let you spread payments over several months.

How to find a plan through Medicare Advantage

Medicare Advantage plans (also called Part C) are sold by private insurance companies and must cover everything Original Medicare covers, plus additional benefits. Some include dental care. If you are enrolled in a Medicare Advantage plan, your plan documents will list what dental services are covered — usually preventive care only, though some plans cover basic and major work too.

To see which plans in your area offer dental coverage, visit Medicare.gov and use the plan finder tool. You can filter by benefits and see which plans include dental. Coverage and costs vary by plan and by region, so two people in the same state may have different options. You can change plans during the annual enrollment period (October 15 to December 7 each year) if your current plan does not cover what you need.

If you do not have a Medicare Advantage plan and want dental coverage, you can buy a standalone dental plan during the open enrollment period on Healthcare.gov, or you can buy directly from an insurance company or through AARP if you are a member.

Waiting periods and annual limits

Most dental insurance plans have a waiting period before they cover major work. Preventive care (cleanings, exams, X-rays) is usually covered when ready with no waiting period. Basic work (fillings, extractions, straightforward repairs) typically has a waiting period of 6 to 12 months. Major work (crowns, root canals, implants, bridges) often has a waiting period of 12 months or longer.

This means if you sign up for a plan in January and need a crown in March, the plan may not cover it until January of the following year. Some plans waive the waiting period if you had continuous coverage with another plan before, so ask about this when you compare plans.

Dental insurance also has an annual maximum — the most the plan will pay in a calendar year. This is usually $1,000 to $2,000. Once you hit the maximum, you pay 100 percent of any remaining costs that year. Discount plans do not have annual maximums, which is one reason some seniors prefer them.

Medicaid dental coverage for seniors

Medicaid is a joint federal and state program, so dental coverage for seniors varies dramatically by state. Some states cover preventive care only. Others cover preventive, basic, and major work. A few states cover very little dental care for adults over 21.

To find out what your state covers, contact your state Medicaid office or visit your state's Medicaid website. You will need to meet income and asset limits to may have access to for Medicaid — these limits differ by state. If you receive Supplemental Security Income (SSI), you likely already may have access to. If you do not, you can ask your state Medicaid office whether you meet the income threshold.

Some seniors may have access to for both Medicare and Medicaid (called "dual may be able to access"). If you are dual may be able to access and your state covers dental through Medicaid, you can use that coverage for dental care.

What to compare when choosing a plan

When you are looking at different plans, make a list of the dentists you want to see and check whether they are in-network for each plan. An out-of-network dentist will cost you significantly more. Also note the monthly premium or annual membership fee, the waiting periods for major work, and the annual maximum (if it is insurance, not a discount plan).

Ask each plan or dentist about the cost of the specific procedures you think you will need — a cleaning, an exam, a filling, a crown. Prices vary widely by region and by dentist. Some plans publish their fee schedules online; others will email or mail them to you. Getting this information in writing before you sign up helps you compare the true cost of each option.

Also check whether the plan covers preventive care at 100 percent with no copay. This is standard, but it is worth confirming. If you have a Medicare Advantage plan, read the plan documents carefully or call the plan's customer service line to ask exactly what dental services are covered and what you will pay out of pocket.

Paying for dental care without a plan

If you do not have dental insurance or a discount plan, you have several options. Many dentists offer in-house payment plans that let you spread the cost over several months with little or no interest. Ask your dentist whether they offer this.

Some dental schools offer reduced-cost care performed by students under supervision. The work takes longer than it would at a regular dentist, but the cost is often 30 to 60 percent lower. Search for "dental school near me" or contact your state dental board for a list.

Community health centers sometimes offer dental care on a sliding fee scale based on your income. You can find one near you at Findahealthcenter.hrsa.gov. Some nonprofits also run free or low-cost dental clinics — search online for "free dental clinic" plus your city name.

Frequently Asked Questions

Does Medicare cover dental care?

Original Medicare does not cover dental care. However, some Medicare Advantage plans include dental benefits. Check your plan documents or call your plan to see whether dental is covered and what the limits are.

Can I use a dental plan right away, or do I have to wait?

Preventive care (cleanings and exams) is usually covered when ready. Major work like crowns or root canals typically has a waiting period of 6 to 12 months. Discount plans have no waiting periods. Ask the plan directly before you sign up.

What is the difference between in-network and out-of-network?

In-network dentists have agreed to accept the insurance company's negotiated rates, so your out-of-pocket cost is lower. Out-of-network dentists have not agreed to those rates, so you pay more. Always check whether your dentist is in-network before you sign up for a plan.

How much does a dental plan cost per month?

Dental insurance premiums typically range from $10 to $30 per month for an individual, though this varies by plan and region. Discount plans charge an annual membership fee of $80 to $200 instead. Get quotes from several plans to compare.

What if I need a lot of dental work done?

If you need major work, a discount plan may be cheaper than insurance because it has no waiting period and no annual maximum. However, if you need ongoing care over several years, insurance may save you money in the long run. Calculate the cost of your specific procedures under each option before deciding.