Can you see a dentist who doesn't take Medicare?
November 1, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome to The American Retirement Advisor. I'm Betty, Eddie's here with me in the studio today, and we are wrapping up our week-long series. This is part five of our dental care in retirement series, based on Ian Schaeffer's piece, and it is the one I have been waiting for, because it answers a question a lot of people wonder about: can I actually use my Medicare Advantage dental benefit at my own dentist, the one I already love, even if she doesn't take Medicare?
And the answer is a very loaded maybe.
Which is somehow both reassuring and annoying at the same time.
That's Medicare in a nutshell, honestly. But Ian Schaeffer's piece does say it's a better maybe than it used to be, and that distinction matters.
Okay, explain that. How has it changed?
So since 2022, Medicare Advantage plans are allowed to pay for extra benefits like routine dental even when the dentist has opted out of Medicare. And here's the part that surprised me when I read it: a dentist doesn't need to be enrolled in Medicare at all for the plan to potentially cover your visit.
Wait, really? Because I think most people assume that if they don't take it, it's just a no.
That used to be closer to true. The reality now is that whether your plan pays has less to do with Medicare enrollment and more to do with your specific plan's own network rules.
So it's not about that anymore, it's a your-plan question.
Exactly. And that means you have to actually open the paperwork for your specific plan and find out where it wants you to go.
Which, I will say, not everyone's first instinct is to do that. And then what? How do you even start?
Your Summary of Benefits. It will point you to the plan's dental directory, or give you a website or a phone number to find in-network dentists. That's your starting place.
And then what you find depends on what kind of plan you have.
Right, and this is where plan design really kicks in. Ian Schaeffer lays out three basic shapes. HMO plans usually require you to use a dentist in their network. PPO plans reward you for staying in-network but don't make it mandatory. And then there are allowance and reimbursement plans that set a yearly dollar amount, and you need to check whether those require a network dentist or not.
So with a PPO you have more flexibility, but you might pay more if you wander outside it.
That's the tradeoff. More freedom, potentially more cost. With an HMO, your options are narrower but the plan structure is usually cleaner.
I think of it like a grocery store with a store brand versus name brand. The store wants you buying their brand, they'll give you a discount on it, but you can still buy the other one, you'll just pay full price.
That works. And with an HMO it's more like, this is the only one we carry. Take it or leave it.
Okay so what actually happens when someone does go out of network? Walk me through the mechanics.
Usually you pay the dentist first, out of pocket at the visit, and then you send the bill to the plan for reimbursement. So you're floating the cost in the meantime.
Which is fine for a cleaning, maybe less fun for a crown.
That's exactly the situation Ian Schaeffer has in mind, and that's why he specifically says: before a big procedure, ask the plan to confirm in writing what it will pay.
That detail matters.
Because verbal confirmation has a funny way of disappearing when the bill arrives. Get it in writing, keep it on file.
What about dental school clinics? Because we hear about those a lot as a way to save money.
Same rules apply. Ask whether the clinic is in your plan's network, or accepted out of network. There's nothing magic about a dental school that automatically makes it covered. It's just another provider from your plan's point of view.
That's actually a useful thing to know because I think people assume it's always a cheaper covered option, and it might be, but you still have to check.
That phrase should be the theme of this whole series.
Now there's one thing in Ian Schaeffer's piece that caught my eye, something called the Preclusion List. What is that?
So this is a list maintained by Medicare of providers who are barred from being paid by Medicare Advantage plans, specifically because of fraud or abuse. It's described as a short list, but it's absolute: your plan cannot pay any dentist on it, period.
And how would you even know if yours ended up on it?
The article says your plan will notify you if a dentist you've seen gets added to it. So it's not something you're hunting down on your own, but it's good to know the mechanism exists.
It does make you feel a little better that there's a system there, even if it's a corner case most people will never run into.
Right, it's probably not going to be your situation. But if it ever is, at least you'll know what happened.
Okay, let's talk about something that I think people completely miss, which is that these benefits change. Every year.
And that's not an accident or a flaw, it's baked into how Medicare Advantage works. Plans can and do change their extra benefits annually.
So the dental coverage you had this year might be different next year, even if you do nothing, even if you don't switch plans.
That's exactly it. Which is why Ian Schaeffer is pretty specific about the calendar. Every September you get something called the Annual Notice of Change, and you need to read the dental section of it.
Not skim it. Read it.
And then if you want to compare what's out there, the Annual Enrollment Period runs October fifteenth to December seventh. That's your window to look at other plans' extra benefits, including dental, and decide if you want to make a move.
I love that he specifies those dates because people always ask, when exactly can I switch? That's the main window.
October fifteenth to December seventh. Mark it.
There's something else Ian Schaeffer says in the article that I want to make sure we don't gloss over. He says the dental is a nice extra, but your doctors, your drugs, and what a bad year would cost you come first.
That's probably the most important sentence in the whole piece.
Because people will sometimes pick a plan based on which one has the best dental, and if the rest of the plan is not right for their situation, that could be a very expensive mistake.
It's nice to have. Access to your specialists and your prescriptions at a cost you can manage is the foundation. Don't trade the foundation for a nice floor.
I'm writing that down.
I'll try to remember I said it.
The article ends with a really practical checklist of questions to ask before your next dental visit. There are six of them, and I won't read all six, but two of them jumped out at me.
Which ones?
The first one: is my dental benefit actually included in my plan, or is it an optional add-on? Because apparently those are different things, and I think a lot of people don't know which one they have.
That's a bigger deal than it sounds. If it's an add-on, there may be separate paperwork, separate networks, separate rules. You can't assume it all works the same way as the rest of your plan.
And the second one that got me: what is my yearly maximum, and how much of it have I used? Because there is a cap, and if you hit it in September and then need a crown in October, you're paying out of pocket.
Timing matters a lot with yearly maximums. And the specific numbers vary a lot from plan to plan, so the question for your own plan is something our team at American Retirement Advisors would be well equipped to help you look up.
The other four questions in the list are in the article, and they're all worth reading through before you pick up the phone to schedule anything. Are crowns and dentures and implants covered? Do I have to pay up front? What's changing next year? Good things to know.
And honestly the fact that they're in a checklist form is a gift. Print it out, take it with you, ask every single question.
Now, we've done five parts on this topic. Can you just quickly remind people what the whole series covered? Because if someone is jumping in here for the first time, they're probably wondering what they missed.
Sure. Part one was whether Medicare pays for your teeth at all. Part two looked at the difference between a discount plan and actual dental insurance. Part three was about where to get dental care for less. Part four was about what your plan's dental really covers. And this one, part five, is where you can actually get that care and how the network piece works.
So it builds. Each one adds a layer.
And all of it comes from the guide Ian Schaeffer put together, Dental Care in Retirement, updated for 2026, specifically for Arizona and Nevada.
And the guide is available at no cost to you, right?
At no cost. And the team there will read it with you. That's the part I want people to hear. You don't have to figure out your own Summary of Benefits alone. Someone will sit down with you.
No pressure, no pitch, just a conversation. That's genuinely how Ian Schaeffer describes it in the article, and it's worth believing.
Call six-oh-two, two-eight-one, thirty-eight ninety-eight. That's the number in the article, and it goes right to the team.
Keep it handy if any of this is hitting close to home.
If you're not sure whether your plan's dental is working for you, or you're in the Annual Enrollment Period and wondering how your options compare, that's the conversation to have.
And if you want to look at your own plan's dental rules and just need someone to help you read the paperwork, same answer. They will do that with you.
There's no reason to guess when that help is right there and they know this stuff.
Alright. That is a wrap on Dental Care in Retirement. Five parts, and I feel like we finally have a complete picture. Thank you for sticking with this series all the way through. If you found any of it useful, share it with someone who's trying to figure out their Medicare coverage, because there are a lot of people who could use this. Take care of yourselves, go check your Summary of Benefits, and we'll talk soon.