Your Medicare Advantage Dental Allowance Has Fine Print Now: Coinsurance, Explained With One Crown
A client called me in the spring after a crown. Same plan she had the year before, same dentist, same tooth that had been bothering her since Christmas. The bill was $250. The year before, the same work had cost her nothing.
Nothing had gone wrong with her claim. Her plan's dental benefit had changed shape on January 1, in a line of the Annual Notice of Change she had not read, and the change has a name most people have never had explained to them: coinsurance.
Many Medicare Advantage plans have moved their dental benefit from "the plan pays, up to an allowance" to "you pay a percentage of every procedure, and the plan pays the rest up to a maximum." The headline dollar figure often looks the same or bigger. What you pay at the dentist's chair does not.
Below: the same $500 crown under both designs, why carriers are making this change, and the three documents where you can check your own plan in about ten minutes. The short version of that last part: look at the comprehensive dental row and find out whether it says a dollar amount or a percentage.
Two words that sound alike and are not
An allowance (also called an annual maximum or benefit maximum) is the most the plan will pay toward dental work in a year. Spend past it and the rest is yours.
Coinsurance is your share of each procedure, as a percentage. With 25 percent coinsurance on a $500 crown, you pay $125 at the counter and the plan pays $375. With 50 percent, you pay $250.
A plan can have an allowance with no coinsurance, an allowance with coinsurance, or in a few cases coinsurance with no allowance at all. The first design is the one most people picture when they hear "dental allowance." The second is the one more and more of them actually have.
The same crown, two ways
Here is the example that makes it click. Two people, two plans, both with a $1,000 annual dental allowance, both needing one $500 crown, both at an in-network dentist with nothing else used that year.
Figure 1. Same crown, same allowance. Coinsurance moves $125 onto you today and leaves more of the allowance unspent. Assumes the plan's share counts against the maximum, which is the usual design.
On Plan A you walk out owing nothing and have $500 left for the rest of the year. On Plan B you walk out owing $125 and have $625 left. Notice that Plan B's allowance lasts longer. That is not an accident, and it is how a plan with coinsurance can advertise a bigger maximum while costing you more at the chair.
Where it goes from there
One crown rarely stays one crown. Watch what happens across a year:
Figure 2. Plan A costs you nothing until the allowance is gone, then the whole third crown is yours. Plan B costs you something every time but stretches the allowance across all three. After three crowns both have cost you $500; the difference is when you paid it and how much the plan contributed in between.
| $500 crown, $1,000 allowance | No coinsurance | 25% coinsurance | 50% coinsurance |
|---|---|---|---|
| You pay at the chair | $0 | $125 | $250 |
| Plan pays | $500 | $375 | $250 |
| Allowance left after one crown | $500 | $625 | $750 |
| Second crown: you pay | $0 | $125 | $250 |
| Third crown: you pay | $500 (allowance gone) | $250 | $250 |
| Three crowns, your total | $500 | $500 | $750 |
Arithmetic, not a quote from any plan. Assumes the plan's paid share counts against the annual maximum, which is the common design. Some plans apply the maximum differently; your Evidence of Coverage says which.
Two things this table teaches. First, if you need one or two things done in a year, coinsurance costs you money that the no-coinsurance plan would have covered entirely. Second, if you need a lot done, the difference narrows or disappears, because the no-coinsurance allowance runs out sooner. Which design is better for you depends on how much dental work you actually expect, which is why "the plan with the bigger allowance" is the wrong question.
Why plans are doing this
This is a national shift, not something that happened only to you. Milliman's analysis of 2026 Medicare Advantage plans found that the value of supplemental benefits the plans added on top of Medicare fell by about $7 per member per month from 2025 to 2026, that standalone comprehensive dental limits declined about 8 percent, and that plans restructured so preventive dental is fully covered while major work carries significant cost sharing. KFF, which tracks the market each year, notes that 98 percent of plans offer dental and that plans routinely change the annual maximum and the cost sharing from one year to the next. Over-the-counter allowances fell about 13 percent in the same period and fewer plans offer transportation.
The reasons the carriers give are the ones you would expect: medical costs rose faster than Medicare's payments to the plans in the 2025 and 2026 rate years, and carriers say they are concentrating benefits where members use them. There is a second, quieter reason that the receipts above make obvious. Coinsurance shares the cost of every procedure with you, and it makes the advertised maximum stretch further. A plan can keep a $1,500 dental figure on the brochure, add 50 percent coinsurance underneath it, and pay out less than it did on a $1,000 allowance with no coinsurance. Neither of those motives is sinister. Both are reasons to read the row rather than the headline.
Why this matters more in Kentucky
Dental benefits are a nice-to-have in some states. Here they are decision-relevant. 24.8 percent of Kentuckians 65 and older have lost all of their natural teeth, the fifth highest rate in the country, against a national figure of about 14 percent. Just over half of Kentuckians over 65 have had six or more teeth extracted, compared with about 40 percent nationally. Fewer than six in ten Kentucky adults saw a dentist last year.
In practical terms, the people reading this page in Lexington, Winchester, Nicholasville, Georgetown and Richmond are more likely than almost anyone in the country to need crowns, extractions, partials and dentures, which is exactly the "comprehensive" category where coinsurance now lives. For a Kentuckian, the dental row is not fine print. It can be the largest out-of-pocket line on the plan.
Sources: Kentucky Department for Public Health oral health data (BRFSS), CDC National Center for Health Statistics data brief on tooth loss among older adults, America's Health Rankings 2024 dental visit measure. Checked October 2026.
How to check whether your plan has coinsurance
Three documents, one phone call, ten minutes. Do this before you need the work, not in the dentist's chair.
Figure 3. An example of how the row usually reads. Preventive at $0 is nearly universal; the comprehensive row is where coinsurance shows up, and it is a percentage, not a dollar copay.
In the Annual Notices of Change my clients have brought me for this coming year, the pattern is the same one Milliman found nationally: plan after plan that paid dental up to an allowance last year now has a percentage sitting under the same dollar figure. The number on the brochure did not move. What moves is the bill.
I do not think most people would have chosen their plan differently if they had known. I do think they would have budgeted differently, and some would have had the crown done in December instead of January. That is what a ten-minute check buys you.
A few traps around the edges
- A "flex card" is not a dental allowance. Some plans load a prepaid card with a combined amount for dental, vision, hearing and sometimes groceries. It spends differently and it can carry its own rules. Our guide to what the Medicare flex card really is covers that.
- Implants are often excluded or capped separately, even on plans that cover crowns and dentures well. Check the exclusions list, not just the maximum.
- Out-of-network can mean zero. On many HMO dental networks there is no out-of-network benefit at all. On others you pay a higher percentage. Confirm your dentist by name in the plan's dental directory.
- The allowance does not roll over. Unused dental benefit disappears on December 31, which is why the timing of major work matters.
If you are weighing whether an Advantage plan's extras are worth the network trade-off in the first place, our honest look at whether Medicare Advantage is worth it is the place to start, and the dental, vision and hearing guide covers what Original Medicare does and does not pay.
Common questions from Kentucky
What is dental coinsurance on a Medicare Advantage plan?
Coinsurance is the percentage of each dental procedure you pay yourself, with the plan paying the rest up to its annual maximum. With 25 percent coinsurance, a $500 crown costs you $125; with 50 percent, $250. It applies to comprehensive services such as fillings, crowns, root canals, extractions and dentures. Preventive care such as exams and cleanings is usually covered at $0 regardless.
What is the difference between a dental allowance and coinsurance?
An allowance, also called an annual or benefit maximum, is the most the plan will pay toward dental care in a year. Coinsurance is your share of each procedure. A plan can have an allowance with no coinsurance, in which case the plan pays procedures in full until the allowance is used, or an allowance with coinsurance, in which case you pay a percentage of each procedure and the plan's share counts against the maximum. The headline allowance can be identical on both designs while what you pay at the dentist is very different.
How do I know if my Medicare Advantage dental benefit has coinsurance?
Look at the comprehensive dental row in your plan's Summary of Benefits. A dollar amount or "$0 copay" means no coinsurance on that service; a percentage means coinsurance. The Evidence of Coverage benefits chart gives the annual maximum, frequency limits, waiting periods and network rules. Each September the Annual Notice of Change shows the dental row for this year and next side by side. Confirm by calling the plan and asking the percentage on crowns, root canals, extractions and dentures.
Why did my plan add dental coinsurance this year?
It is part of a national shift. Milliman's analysis of 2026 plans found supplemental benefit value fell about $7 per member per month from 2025, standalone comprehensive dental limits fell about 8 percent, and plans restructured so preventive dental is fully covered while major work carries significant cost sharing. Carriers cite medical costs rising faster than Medicare payments. Coinsurance also shares each procedure's cost with the member and makes the advertised maximum last longer.
Can my dental benefit change next year even if I keep the same plan?
Yes. Medicare Advantage plans can change the dental annual maximum, add or raise coinsurance, change frequency limits and change the dental network each January while keeping the same plan name. The Annual Notice of Change you receive by September 30 lists these changes in its benefits table. Read the dental row every fall before deciding whether to stay.
Is a $1,500 allowance with 50 percent coinsurance better than $1,000 with none?
Not automatically. On a single $500 crown, the $1,000 no-coinsurance plan costs you $0 and the $1,500 plan with 50 percent coinsurance costs you $250. The larger plan only pulls ahead if you need enough work to exhaust the smaller allowance, roughly $1,000 or more of dental in a year. The right comparison is how much dental work you realistically expect, not which number is bigger on the brochure.
Not sure what your dental row says?
Bring me your Annual Notice of Change, or the name of your plan, and I will read the dental row with you and tell you what a crown would actually cost on it next year. No charge. If your plan is still the right one, you will hear that too.
Or call me directly: (859) 618-6443
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Written and reviewed by Austin Tyler, licensed Kentucky agent, NPN 20234188, Kentucky DOI license #1187780. National benefit-design figures from KFF and Milliman; Kentucky oral health figures from Kentucky DPH and CDC, October 2026.
This article is general information, not advice for your specific situation. The dollar examples are illustrations of how allowances and coinsurance work and are not quotes from any plan; your plan's actual maximums, coinsurance, frequency limits, networks and exclusions are in its Evidence of Coverage and can change each year. No specific plan is named or recommended. Tyler Insurance Group is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent 6 organizations which offer 158 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.