Medicare Advantage Dental Allowance vs Medigap Plan G: What a Crown, Hearing Aids, and a Nursing Home Stay Cost in 2026 Depending on Where You Buy

Annual Notice of Change letters are due from your plan by September 30. Open Enrollment runs October 15 to December 7, and what you choose starts January 1. Before then you have three decisions:

1. Keep, switch, or leave your Medicare Advantage (MA) plan. You can change it during Open Enrollment.
2. Re-compare your Part D drug plan. Formularies change every year.
3. Decide whether to stay on Original Medicare with a Medigap supplement. This is the one you can't easily undo, because Medigap insurers in most states can medically underwrite you once your guaranteed-issue window closes.

This post is about the gaps behind those decisions. Original Medicare pays $0 for routine dental care, hearing aids, and custodial nursing home care. What you pay instead depends on four things:

• Your plan type.
• Whether you've met your deductible.
• Where you live.
• Which specific facility you book.

The same crown can cost $1,100 at one office and $3,200 at another. This post shows how much that difference matters under each plan type.

What five recent news stories say about your January bill

We read five recent stories to see what they imply for a coverage-gap budget.

Cost shock is already political. KFF Health News's "Sticker Shock at the Doctor's Office Could Motivate Midterm Voters" describes steep jumps in premiums and deductibles as top of mind heading into the midterms. Whatever you think of the candidates, your January 1 costs are set by documents that are already in your mailbox. That's the argument for reading your plan's Evidence of Coverage now.

Your eligibility isn't always permanent. Medicare Rights' "Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year" covers its comments on a proposed CMS rule implementing H.R. 1's Medicare eligibility changes for certain immigrants. Medicare Rights urged CMS to mitigate the harm. If this affects you or someone you help, the coverage-gap numbers below become the whole bill, not just the extras. Call your State Health Insurance Assistance Program (SHIP) before year-end.

Medicaid is the quiet backstop for dental, vision, and long-term care. KFF Health News's "A Cancer Survivor Hoped To Work — Then She Lost Her Medicaid Disability Coverage" shows how state reviews of who counts as disabled can end coverage for people who assumed it was secure. If Medicaid currently fills the gaps Medicare leaves, ask what your plan is if that changes.

Coverage isn't proof the evidence is settled. KFF Health News's report on the FDA reads "The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren't Done." It notes that many postmarket studies are behind schedule or overdue. This is no reason to panic. It's a reason to ask your prescriber whether a newer drug or device has a cheaper established alternative, and to price both.

What each plan type pays for the gaps

Service	Original Medicare	Original Medicare + Medigap Plan G	Typical MA PPO
Routine dental (crowns, dentures, cleanings)	$0	$0	Often an annual allowance or copays; varies widely
Hearing aids	$0	$0	Often an allowance or fixed-price vendor benefit
Diagnostic hearing exam (ordered by a doctor)	20% after the $283 Part B deductible	Plan G pays the 20% but not the deductible	Copay set by plan
Routine eye exam and glasses	$0 (limited exceptions after cataract surgery)	$0	Often a modest eyewear allowance
Skilled nursing facility (SNF), days 1–20	$0 after a 3-day inpatient stay	$0	Plan-specific
SNF, days 21–100	$217/day	$0	Plan-specific daily copay
Custodial nursing home care	$0	$0	$0

Two details in that table decide many bills.

The 3-day rule. Original Medicare's SNF benefit requires three inpatient midnights. Days spent under "observation" don't count. Ask the hospital which status you're in.

Custodial care. Help with bathing, dressing, and eating is not covered by any of the three columns. A private-pay nursing home commonly runs around $9,500 a month in many markets, and the real number in your state can be very different. The story of a cancer survivor losing Medicaid is really a long-term care story: Medicaid is often the only payer.

Our full breakdowns of what Original Medicare and Medicare Advantage actually pay for a crown and hearing aids and of the nursing home coverage cliff after day 100 go deeper on each service.

This is the kind of analysis Toravine runs for you, so you don't have to build the spreadsheet yourself.

Worked example: one year, one crown, one pair of hearing aids, one hospital stay

Here is a deliberately busy year. The person needs a crown and a pair of hearing aids. They also have a 5-day inpatient hospital stay followed by 30 days in a skilled nursing facility.

These are my assumptions, not Toravine findings. Replace them with your own quotes.

• Plan G premium: $170/month ($2,040/year).
• Standalone dental plan: $45/month ($540/year), paying 50% of in-network crowns.
• MA PPO: $0 premium, $1,500 dental allowance, $1,000 hearing allowance, $350/day hospital copay for days 1–5, and $200/day SNF copay from day 21.
• Both paths pay the same Part B premium ($202.90/month in 2026) and the same Part D, so both are left out.
• Plan G leaves the $283 Part B deductible to you. Plan G covers the $1,736 Part A deductible and the SNF coinsurance ($217/day × 10 days = $2,170).
• Two markets:
  • Low-price market: crown $1,100 and hearing aids $1,800 at retail. Negotiated in-network prices are $1,000 and $1,800.
  • High-price market: crown $3,200 and hearing aids $4,700 at retail. Negotiated in-network prices are $1,900 and $2,400.

Total out-of-pocket for the year:

Path	Low-price market	High-price market
Plan G, no dental coverage (pay retail)	$5,223	$10,223
Plan G + standalone dental (crown in-network, hearing at retail)	$5,163	$8,513
MA PPO, everything in-network	$4,550	$5,550
MA PPO, but you keep your out-of-network dentist and hearing clinic	$6,650	$11,650

Here is how one line adds up. Plan G with no dental coverage in the high-price market is $2,040 premium + $283 deductible + $3,200 crown + $4,700 hearing aids = $10,223.

The MA in-network line in the same market is:

• Crown: $1,900 − $1,500 allowance = $400.
• Hearing aids: $2,400 − $1,000 allowance = $1,400.
• Hospital copays: $1,750.
• SNF copays: 10 days × $200 = $2,000.
• Total: $5,550.

The swing inside the MA plan is $6,100 ($5,550 vs $11,650), and it comes entirely from whether your providers are in the network. The difference between plan types is smaller than the difference between provider choices.

The 10-year math

Plan G's premium at 5% annual increases (an assumption) is:

$2,040 × (1.05¹⁰ − 1) ÷ 0.05 ≈ $25,660 over 10 years

Add the $283 Part B deductible each year (about $2,830 total, held flat). That's about $28,500 before Plan G pays a dollar toward dental or hearing. That works out to roughly $2,850 a year, the average extra cost-sharing an MA plan has to produce before Plan G comes out ahead.

In the example, the hospital-and-SNF year cost the MA plan $3,750 in copays, which is above that line. An ordinary year costs far less. So the real question is how often you expect a year like that.

That's why the answer differs by person. It also shows why Medigap is the irreversible piece. If you start on MA and want Plan G later, most states let insurers underwrite you on health history. The exceptions are New York, Connecticut, Massachusetts, and Maine, which have different rules, and a few situations with guaranteed-issue rights. Read our guide to the enrollment windows that let you switch without underwriting before you drop a Medigap policy.

You can model this for your specific situation at Toravine.

The four variables that decide your number

1. Your deductible status. If you've met your Part B deductible this year, a January procedure under Plan G costs you nothing extra. If you switch plans, you start over on a new plan's deductible. Timing a procedure around your plan year can change the bill.

2. Your location. Toravine's data layer combines 11,267 rows from four sources: Census ACS Medicare demographics (6,287 rows), CMS plan premium data (1,236), Medigap rates (3,570), and CMS IRMAA brackets (174). The reason for putting them together is that Medigap quotes and MA plan availability differ by ZIP, age, and how the insurer prices. The $170 above is a placeholder, not a market average. Your own quote is the number that matters.

3. The specific procedure and facility. Before you schedule anything:

• Dental: ask for a written estimate with the procedure code (a crown is usually D2740) from two offices. Ask a dental school clinic too, if there is one nearby.
• Hearing: ask for the price of the device and the fitting separately. Over-the-counter hearing aids are now an option and can cost far less than clinic-dispensed pairs.
• Nursing homes: ask for the private-pay daily rate, whether they accept Medicaid when savings run out, and whether your MA plan has them in network.

4. Your network and prior authorization. Before Open Enrollment, look up your current dentist, audiologist, and preferred SNF in the new plan's directory. For MA, ask whether the allowance applies out of network. Many don't.

When your backstop disappears

Two of the news stories share a theme. Coverage you counted on can change for reasons outside your plan choices. Ask yourself these questions now:

• If Medicaid or another program currently covers your dental, hearing, or long-term care, what is your plan if it doesn't next year?
• If your eligibility is in question, have you talked to your SHIP counselor or Medicare Rights before December 7?
• If you have limited income, check whether you qualify for a Medicare Savings Program. The asset test can block people who look eligible.

A pre-October 15 checklist

1. Find your Annual Notice of Change. Compare the dental and hearing allowances, the SNF copays, and the out-of-pocket maximum.
2. Get two written quotes for any dental or hearing work you expect to need.
3. Check every doctor, dentist, and facility you use against the new network directory.
4. If you're on Original Medicare with Medigap, do not cancel it until you know whether you'd pass underwriting to get it back.
5. Look at how MA plans change at annual enrollment before you accept an auto-renewal.

The best plan on paper doesn't tell you what you'll pay. Your price at your dentist, your clinic, and your nursing home, inside or outside your network, does.

Run your own numbers before you schedule

Every figure above depends on the inputs you can only get locally: your Plan G quote, your MA plan's allowances, and the prices at facilities near you. If you want to compare your current plan against the alternatives before December 7, Toravine lets you enter your own plan details, ZIP code, and expected procedures and see the annual and 10-year totals side by side.

Data behind this post

The figures above are computed from the product's own reference tables, last refreshed 2026-09-13:

• 6,287 rows from census_acs_medicare
• 174 rows from cms_medicare_irmaa
• 1,236 rows from cms_medicare_plan_premiums
• 3,570 rows from medigap_rates

Sources

• Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year — Medicare Rights Center
• The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren’t Done. — KFF Medicare
• Health Journalists Visit Conservative Georgia District and Weigh AI Bioweapon Threat — KFF Medicare
• Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters — KFF Medicare
• A Cancer Survivor Hoped To Work — Then She Lost Her Medicaid Disability Coverage — KFF Medicare