Examining Medicare rules for dental services

Dear Toni: I am currently on COBRA with dental benefits. I will need dental insurance when I lose my COBRA benefits after enrolling in Medicare at 65 in March. The only dental plans I am finding are in Medicare Advantage HMO/PPO plans. The office manager of my cardiologist's office advised me not to go in the Medicare Advantage direction since Medicare Advantage plans are no longer accepted at his office beginning January 1, 2026. This office only accepting Medicare and group health insurance. Is there a specific dental plan that Medicare offers? Please advise me what I should do, Toni.

Faye, Memphis, Tenn.

Hello, Faye: "What ISN'T Covered by Part A & Part B?" is explained on page 55-56 of the 2026 Medicare & You handbook. There it states: "Medicare doesn't cover everything. If you need certain services Part A or Part B doesn't cover, you'll have to pay for them yourself unless:

You have other coverage (including Medicaid) to cover the costs.

You're in a Medicare Advantage Plan or Medicare Cost Plan that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services."

Some of the items and services that Original Medicare does not cover on page 55. They include: long-term care, eye examinations (for prescription eyeglasses and corrective contact lenses), cosmetic surgery, massage therapy, routine physical exams, hearing aids and exams for fitting them, concierge care and covered items or services you get from a doctor or other provider who has opted out of participating in Medicare. (the last item is discussed further on page 60).

On page 56, the Medicare handbook explains that Original Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures. Original Medicare may pay for dental services that are specific to medical procedures such as a heart valve repair or replacement, an organ transplant, and cancer-related treatments. (Chapter 2 of Toni's "Medicare Survival Guide Advanced Edition" also discusses what is not covered by Medicare.)

Since Medicare does not cover dental care, I would recommend that you talk to your dentist and see which dental insurance plans he/she prefers.

When buying a dental plan, there are two types of dental plans to pick from:(Verify which type of plan your dentist accepts before buying)

Traditional (or indemnity) dental insurance plans: higher in premium, and the preventive services are usually covered at 100%, basic restorative work is covered up to 80% and major procedures at 50%. Recently, new dental plans have been released which help with the cost of dental claims such as fillings, crowns, and root canals. A major surprise is that these plans begin immediately with no wait.

Discount dental insurance plans: less expensive than traditional dental plans. These plans provide a discount for services. Your dentist must be part of the plan's network and agree to give the dental discount.

Toni's new course, "Confused about Medicare" video series, and the "Medicare Survival Guide Advanced Edition" are available at www.tonisays.com. Have a Medicare, Social Security or dental insurance plan question, email [email protected] or call 832-519-8664. Sign up for the Toni Says newsletter on the Toni Says website at tonisays.com to keep up to date with Medicare changes.