Here is a question that sounds like it should have a simple answer: if your dentist doesn't take Medicare, can your Medicare Advantage plan still pay for your dental care?
The answer is maybe, and it's a better maybe than it used to be. This is the last part of our series built from our newest guidepost, and it's about the last of three steps for using the dental in your plan: what's covered, how it's covered, and where you can get your care.
Where does your plan want you to go?
Your Summary of Benefits will point you to the plan's dental directory, or a website or phone number for finding in-network dentists. How much the network matters depends on the plan's design:
- HMO plans usually require a dentist in the network.
- PPO plans reward you for using the network but don't require it.
- Allowance and reimbursement plans set a yearly amount. Check whether they require a network dentist.
What happens if you go out of network?
Your plan's papers say whether out-of-network care is covered and how much. Usually you pay the dentist first and send the bill to the plan for reimbursement. Before a big procedure, ask the plan to confirm in writing what it will pay.
What about dentists who don't take Medicare?
Since 2022, Medicare Advantage plans may pay for extra benefits like routine dental even when the dentist has opted out of Medicare, and a dentist doesn't need to be enrolled in Medicare at all for that. Whether your plan pays depends on its own network rules.
A dental school clinic is no different. Ask whether it's in your plan's network, or accepted out of network.
One limit: a plan can't pay any dentist on Medicare's Preclusion List, a short list of providers barred for fraud or abuse. Your plan will let you know if a dentist you've seen is added.
Why check every fall?
Dental benefits change from year to year. Read the dental section of your Annual Notice of Change each September, and compare plans' extra benefits during the Annual Enrollment Period, October 15 to December 7. Just remember the dental is a nice extra. Your doctors, your drugs and what a bad year would cost you come first.
What should you ask before your next visit?
- Does my plan include dental, or is it an optional add-on?
- Is my dentist in the plan's dental network?
- What is my yearly maximum, and how much have I used?
- Are crowns, dentures and implants covered, and at what cost?
- Do I need to pay up front and file for reimbursement anywhere?
- What changes in the dental benefit next year?
The whole series in one place
- Part 1: Does Medicare pay for your teeth?
- Part 2: Discount plan or dental insurance?
- Part 3: Where can you get dental care for less?
- Part 4: What does your plan's dental really cover?
Everything in this series comes from our guide, Dental Care in Retirement, updated for 2026 for Arizona and Nevada. Whether you're weighing a dental plan or trying to use the one you have, our team can help you find the paperwork and read it with you. No pressure. No pitch. Just a conversation. Call (602) 281-3898.
This is Part 5 of Dental Care in Retirement, a five-part series from our newest guidepost. For education only. Not a recommendation of any plan, company or clinic.
Disclaimer: This article is for educational purposes only. It is not sponsored, endorsed, or otherwise representative of Medicare or the federal Medicare program. American Retirement Advisors is not a government agency. For official Medicare information, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).