Major Changes Coming to Aetna Medicare Dental Plans in 2026
If your office treats patients with Aetna Medicare Signature (HMO-POS) plans, heads up — there are big shifts coming in 2026 that could affect treatment acceptance, billing, and collections.
In 2025, many Aetna Medicare dental plans offered $0 copays across the board for covered services like restorative work, perio, endo, prosthodontics, and even oral surgery. Starting January 1, 2026, those same services will move to a coinsurance model — meaning patients will now owe anywhere from 20% to 70% of the treatment cost depending on the category.
📉 What’s Changing
Here’s a snapshot:
Restorative, perio, and endo services → 20–50% coinsurance (previously $0)
Fixed and removable prosthodontics → 50% coinsurance
Oral surgery → 20–50% coinsurance
Adjunctive services → 20–50% coinsurance
Implants, ortho, and maxillofacial prosthetics → still not covered
🧾 What This Means for Your Office
Expect more patient confusion and higher out-of-pocket balances in 2026. Patients who were used to $0 copays will likely be surprised to learn they now owe a portion of the bill — which could slow down case acceptance or increase collection delays.
Offices should:
Update insurance verification templates for all Aetna Medicare plans effective 1/1/26
Add clear coinsurance disclaimers on treatment estimates
Train front-desk teams to confidently explain that Aetna is shifting from “fully covered” to “cost-sharing”
Encourage patients to complete treatment before year-end 2025 to lock in $0 copays while they’re still active
💡 Our Take
Aetna’s update isn’t small — it’s a major move toward reducing their dental payouts and pushing costs to the patient. For offices, it means more admin time verifying benefits, clarifying coverage, and tracking balances. For patients, it means higher bills and potential hesitation to proceed with treatment.
As always, education and preparation are your best tools. Start reviewing which of your active patients have Aetna Medicare coverage now — and communicate early about how these changes may affect their 2026 treatment plans.
Atlantic Dental Consulting helps dental offices stay ahead of insurance changes, verify accurately, and keep collections consistent — even when plans shift.
