Medicare Advantage dental benefits, explained and accepted here.
Original Medicare (Parts A and B) does not pay for routine dental care — no checkups, cleanings, fillings, root canals, gum treatment, or dentures. That coverage comes from a private Medicare Advantage (Part C) plan, and Virginia has competitive ones. At Todays Dental Alexandria we accept Medicare Advantage dental benefits, file your prior authorizations for you, and explain exactly what your plan pays before treatment starts — call 703-256-2085 and we will verify your benefits with you on the phone.
Understanding how Medicare handles dental care starts with the difference between Original Medicare and Medicare Advantage. Original Medicare (Parts A and B), managed directly by the federal government, does not include coverage for routine dental checkups, cleanings, fillings, root canals, gum treatments, or dentures.
Under Section 1862(a)(12) of the Social Security Act, Original Medicare excludes routine oral health services. It covers dental procedures only in very rare, medically integrated situations:
Because everyday dental health is not covered under Parts A and B, millions of seniors and eligible adults enroll in a private Medicare Advantage (Part C) plan to get comprehensive dental benefits.
Medicare Advantage plans contract directly with the federal government to deliver standard healthcare while adding supplemental benefits such as routine dental packages. Those plans sort dental services into three levels:
Many plans also provide an annual dental dollar maximum, or a reloadable health spending flex card that gives you a dedicated allowance for dental visits each year.
A prior authorization (PA) is an advance review: our dental team sends your proposed treatment plan, X-rays, and clinical notes to your Medicare Advantage plan for approval before major work starts. It exists to protect you — it confirms the plan agrees the treatment is necessary, checks your tooth against the plan’s guidelines, and sets out exactly what the insurance will pay, so no unexpected bill arrives later.
Routine cleanings, regular exams, cavity-check X-rays, and emergency visits for pain relief never require prior authorization. Major treatment almost always does:
We handle the whole submission for you — up-to-date digital X-rays showing the full tooth and root tip, a gentle gum-measuring check (periodontal chart), and a written clinical explanation of why the tooth needs that care. Plans take 7 to 14 business days to return an approval voucher; urgent emergency requests can be decided in as little as 72 hours. Under federal Medicare rules, participating providers may not perform unauthorized major procedures and then balance-bill you, so waiting for the official approval is what keeps your care covered and affordable.
If you qualify for both Medicare and Virginia Medicaid — administered through the unified Cardinal Care program, which includes the Commonwealth Coordinated Care Plus and Medallion populations — you can enroll in a Dual Eligible Special Needs Plan such as Anthem HealthKeepers Dual Plan, Sentara Medicare Dual Care, or UnitedHealthcare Dual Complete.
These plans streamline your care under a single coordination system. Medicare pays first and Virginia Cardinal Care Medicaid pays second, so covered dental procedures carry $0 copayments, $0 deductibles, and no surprise expenses. Under federal and state balance-billing protections, our office is forbidden from billing dual-eligible members for remaining balances on covered services.
Many Virginia D-SNP plans also include a supplemental flex spending card with an annual allowance between $1,500 and $3,500 that can be used at the dental office toward dentures, extractions, crowns, and other essential care.
A few practical rules decide how far your Medicare dental benefit goes:
Important: benefits, allowances, and frequency limits are set by your individual plan and change from year to year. Everything on this page describes how Virginia Medicare Advantage dental benefits generally work — it is patient education, not a quote or a guarantee of payment. We verify your specific plan before treatment begins.
How Medicare Advantage plans typically cover each level of dental care, and how often. Benefit levels, allowances, and frequencies vary by carrier and plan year — our team verifies your specific plan before treatment.
Virginia beneficiaries have access to competitive Medicare Advantage plans from regional and national carriers, each customising network access, cost-sharing, and pre-funded spending cards across Northern Virginia, Central Virginia, the Tidewater region, and Western Virginia. Allowance ranges below describe how these plans generally work — your own plan's figures are what count, and we verify them before treatment.
| Carrier | Coverage and coordination in Virginia |
|---|---|
| Anthem Blue Cross and Blue Shield Virginia (Anthem HealthKeepers, Anthem MediBlue HMO / PPO) | Virginia's largest managed care network, with statewide coverage and $0 preventive checkups and cleanings. Standard plans carry annual comprehensive dental allowances generally in the $1,200–$2,500 range, managed through the dental network or Anthem's pre-loaded benefits card. |
| Sentara Medicare (formerly Optima Health / Sentara Health Plans) | Deeply rooted across Hampton Roads, Central Virginia, and the Blue Ridge region. Closely coordinated care with local dental networks, $0 preventive copays, dental allowances generally in the $1,500–$3,000 range, and integrated pharmacy and medical coordination for major procedures. |
| UnitedHealthcare (AARP Medicare Advantage, UHC Dual Complete D-SNP) | Extensive statewide network participation. Members get coverage for basic and major care, and dual-eligible enrollees receive annual allowances generally in the $2,000–$3,500 range through the UnitedHealthcare UCard for dentures, crowns, and periodontal treatment. |
| Humana (Humana Gold Plus HMO, Humana Choice PPO, Humana Dual Plus D-SNP) | Widely chosen across both metropolitan centres and rural counties in Virginia. Many plans include comprehensive dental riders or the Humana Healthy Options spending allowance, reducing out-of-pocket cost for crowns, extractions, and denture care. Look up your 2026 dental benefits by the DEN code on your card → |
| Aetna Medicare (Aetna Medicare Eagle, Aetna Medicare Advantra PPO) | $0 preventive dental copays with flexible comprehensive allowances or reimbursement flex cards, giving access to in-network providers and out-of-network allowances on select PPO models. |
Preventive care catches cavities and gum problems early, before they turn into painful, expensive ones. For almost every Medicare Advantage member in Virginia these services are covered at 100% — you pay $0 at an in-network dental office.
| Service | What this care does for you | How often it is covered |
|---|---|---|
| Routine dental checkup (periodic exam) | A regular checkup where your dentist examines teeth, gums, and oral tissues for early signs of decay or infection. | Twice per year (usually once every 6 months) |
| New patient comprehensive exam | A complete, thorough oral evaluation for new patients, or patients returning after an extended time away. | Once every 3 years per dental office |
| Emergency problem-focused exam | An urgent visit focused on diagnosing sudden tooth pain, swelling, an abscess, or an accidental mouth injury. | Whenever an urgent emergency occurs |
| Comprehensive gum check (periodontal exam) | A specialised evaluation where the dental team measures gum pocket depths around every tooth to check for gum disease. | Once per calendar year |
| Full mouth X-ray series | A complete set of detailed individual X-rays capturing the crown, root, and supporting bone of every tooth. | Once every 3 to 5 years (shares frequency with panoramic X-rays) |
| Bitewing cavity check X-rays | Targeted X-rays of your back teeth to detect hidden cavities between teeth and evaluate bone height around the roots. | Once every 12 months (typically a set of 2 to 4 films) |
| Panoramic full-jaw X-ray | A single sweeping image that captures an all-in-one view of your upper and lower jaws and sinuses. | Once every 3 to 5 years |
| Single emergency tooth X-ray | A targeted close-up image of one painful tooth, from the chewing edge down past the root tip. | During urgent visits, to diagnose pain or infection |
| Routine adult dental cleaning | A professional cleaning that polishes teeth and removes plaque and hardened tartar above the gumline. | Twice per calendar year (once every 6 months) |
| Protective fluoride application | A professional mineral varnish brushed over enamel and exposed roots to strengthen teeth and shield against decay. | 1 to 2 times per year for adults at elevated risk of cavities |
When a tooth decays or an early infection sets in, basic care repairs and preserves your natural teeth. Virginia Medicare Advantage plans typically cover 50% to 80% of the cost after your annual deductible; Dual Eligible (D-SNP) plans generally cover these services in full.
| Service | What this care does for you | How often it is covered |
|---|---|---|
| Silver (amalgam) fillings | Durable metal fillings placed on back chewing teeth to restore structure damaged by decay. | Once per tooth surface every 24 months |
| Tooth-colored (composite) front fillings | Natural-looking, tooth-colored resin fillings designed to blend with your front teeth. | Once per tooth surface every 24 months |
| Tooth-colored (composite) back fillings | Aesthetic fillings matched to the color of your premolars and molars. | Once per tooth surface every 24 months |
| Emergency pain relief (palliative visit) | A quick, soothing minor procedure during an emergency visit to stop severe toothache pain or pressure. | As needed when severe tooth pain occurs |
| Temporary sedative fillings | A gentle medicated filling placed in an aching tooth to calm irritated nerves and protect it until definitive care. | Once per tooth when clinically necessary |
| Deep cleaning (scaling & root planing) | A therapeutic deep cleaning below the gumline that clears diseased bacteria and hardened tartar from tooth roots. | All 4 quadrants once every 2 to 3 years |
| Full mouth heavy buildup cleaning | A preliminary cleaning that removes heavy calcified buildup so your dentist can properly see and examine your teeth. | Once every 3 years when heavy deposits are present |
| Periodontal maintenance cleanings | Ongoing specialised cleanings every few months to keep gum disease under control after a deep cleaning. | 2 to 4 times per year for patients with treated gum disease |
| Front tooth root canal | Treats deep nerve infection in front teeth by gently cleaning and sealing the canal, saving your natural tooth. | Once per tooth per lifetime |
| Middle tooth (bicuspid) root canal | Removes infected nerve tissue from premolars, stopping toothache pain and preventing root abscesses. | Once per tooth per lifetime |
| Back tooth (molar) root canal | Relieves deep infection and treats multiple canals in large back chewing teeth so they can be saved and crowned. | Once per tooth per lifetime |
| Simple tooth extraction | Gentle, routine removal of a severely broken, decayed, or loose tooth that can no longer be repaired. | Whenever a tooth cannot be saved by other treatment |
Major treatment restores chewing function and appearance when teeth are missing or heavily broken. Standard Medicare Advantage plans usually cover up to 50% of major care, while D-SNP plans offer enhanced coverage up to your annual maximum benefit.
| Service | What this care does for you | How often it is covered |
|---|---|---|
| Permanent dental crowns (caps) | Custom porcelain, ceramic, or metal caps that cover and protect a cracked, weakened, or heavily decayed tooth. | Once every 5 years per tooth |
| Core buildup & foundation posts | High-strength filling materials and posts placed inside a tooth to give a new crown a strong base. | When a tooth lacks enough natural structure to hold a crown |
| Recementing loose crowns or bridges | Cleaning and cementing an existing permanent crown or bridge back into place after it works loose. | Once every 12 months, after the first 6 months of placement |
| Complete full dentures | Custom-fitted, natural-looking removable full plates that replace an entire upper or lower arch of missing teeth. | Once every 5 years per arch (upper or lower) |
| Immediate full dentures | Dentures made in advance and placed the same day the remaining teeth are extracted, so you are never without teeth. | Once per lifetime per arch |
| Removable partial dentures | Lightweight metal or flexible plates holding replacement teeth that clip securely around your remaining healthy teeth. | Once every 5 years per arch |
| Denture relines (tightening loose dentures) | Fresh acrylic lining added to the underside of an existing denture so it fits snugly against shrinking gums. | Once every 2 to 3 years (after 6 months from new dentures) |
| Denture adjustments & broken tooth repairs | Smoothing sore spots on the plastic base, or fixing broken clasps and cracked artificial denture teeth. | Up to twice per year, to keep dentures comfortable |
| Surgical extractions | Careful extraction of broken-down teeth or roots that need minor gum lifting or bone removal to come out safely. | For severely damaged or fractured teeth |
| Impacted tooth removal | Surgical removal of teeth such as wisdom teeth that are trapped under gum tissue or embedded in jawbone. | When trapped teeth cause pain, cysts, or crowding |
| Jawbone smoothing (alveoloplasty) | Surgically reshaping and smoothing sharp ridges of jawbone after extractions so new dentures fit comfortably. | When 3 or more teeth in a row are removed before dentures |
We accept the Medicare Advantage dental plans below. Bring your plan card to your visit and our team will verify your dental benefits before treatment.
Everything you need to know before your first visit. Have another question?
Call 703-256-2085 →No. Original Medicare (Parts A and B) excludes routine dental checkups, cleanings, fillings, root canals, gum treatment, and dentures under Section 1862(a)(12) of the Social Security Act. Routine dental coverage comes from a private Medicare Advantage (Part C) plan instead.
Only in very rare, medically integrated situations — clearing an active mouth infection before open-heart valve surgery, examining and treating teeth before radiation therapy for head and neck cancer, or helping reconstruct a jaw injured in a severe traumatic accident.
Yes. We accept a wide range of Medicare and Medicare Advantage plans, including the major Virginia carriers — Anthem Blue Cross and Blue Shield Virginia, Sentara Medicare, UnitedHealthcare, Humana, and Aetna Medicare. The accepted plan list on this page has the full set, and we verify your specific plan before treatment.
Most standard Medicare Advantage plans cap the dental benefit between $1,000 and $2,500 per calendar year; enhanced D-SNP plans may offer $3,000 or more. Preventive care is typically covered at 100%, basic care at 50% to 80% after any deductible, and major care up to about 50%. We check your remaining benefit before scheduling.
New crowns, foundation core buildups, molar root canals, deep gum cleanings, full or partial dentures, denture relines, surgical extractions, and jawbone smoothing. Cleanings, exams, cavity-check X-rays, and emergency pain-relief visits do not. Plans take 7 to 14 business days to decide; urgent requests can come back in as little as 72 hours.
No — we handle the entire submission. We take the digital X-rays, complete the periodontal chart, write the clinical explanation, and send it to your plan. Federal rules prohibit participating providers from doing unauthorized major work and then billing you for it, so we always wait for the official approval.
You can enroll in a Dual Eligible Special Needs Plan (D-SNP). Medicare pays first and Virginia Cardinal Care Medicaid pays second, so covered dental procedures carry $0 copayments and $0 deductibles. Under balance-billing protections we cannot bill you for the remainder on covered services.
Routine Medicare Advantage dental riders exclude purely cosmetic treatment — teeth whitening, cosmetic veneers, and sports mouthguards. Dental implants and implant-supported prosthetics are excluded unless your plan includes an upgraded implant rider. We will tell you the cost upfront if you want treatment your plan does not cover.
We review your benefits up front and lay out every option in plain language — so cost is never the reason care gets delayed.
We work with most major providers, plus Medicaid and Medicare for adults and children.
View all insurance options →In-house payment plans and third-party financing so treatment fits your budget, not the other way around.
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4601 Pinecrest Office Park Dr Ste D, Alexandria, VA 22312, USA
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