Saturday, March 23, 2024

Can You Get Dental Insurance On Medicare

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Dental Coverage With Original Medicare Part A And Part B

Get Medicare with Dental Coverage from UnitedHealthcare

Original Medicare is composed of Part A, which is hospital insurance, and Part B, medical insurance. The only instance in which Original Medicare might cover any dental services is if you suffered a traumatic injury that also affected your jaw, teeth, or mouth and had to be hospitalized. Then, Original Medicare may cover some of that dental care.

Understanding exactly what your Medicare plan would cover is important to know before accidents occur.

Does Original Medicare Include Cover Teeth Cleanings Or Dentures

Original Medicare does not provide coverage for most dental care. Part A will cover certain dental services that are administered in a hospital and may provide some coverage for emergency dental care or complicated dental procedures.

Routine care like cleanings, dentures, extractions and fillings, however, are not covered.

For example, Medicare may cover the cost of an oral examination that is necessary to prepare a patient for a kidney transplant. But a routine dental examination, checkup or cleaning would not be covered.

Without much help from Original Medicare, Medicare beneficiaries are essentially left with three options for paying for their dental care:

  • Paying out of pocket

So Where Should You Go For Dental Coverage

Medicare Advantage plans, which are private health insurance plans, cover everything that Medicare Parts A and B cover, and some of them also offer dental benefits. Many cover routine preventive care, such as cleanings, X-rays, and regular exams, either partially or in full. You may also find coverage for things like extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.

Like other private health insurance plans, Medicare Advantage plans come in a variety of types, including HMO and PPO plans, as well as private fee-for-service plans. And Medicare Advantage plans generally have a monthly premium in addition to the premium for Medicare Part B, which is $144.60 in 2020.

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But there are some disadvantages to Medicare Advantage plans, such as a more limited list of approved doctors and hospitals. So make sure you understand what youre getting. You will also need to use a dentist in the Medicare Advantage network, so if you have a dentist you like, check to see if they are in the network. Compare costs and benefits for plans in your area before buying. You can search for a plan using Medicares Plan Finder.

Otherwise, if you stick with Medicare as your primary insurance, youll need to get separate dental insurance or pay for dental care out of pocket. You can check the costs of private dental plans using a broker site online.

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Will Dental Care Ever Be Covered By Medicare

Adding dental coverage to Medicare Part B is on the legislative agenda for 2022. This type of initiative has previously failed, but there is currently more support for it than ever before. There are no details yet about the proposed plan benefits or costs.

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Services Excluded Under Part B

How Can I Get Dental Coverage On Medicare

The following two categories of services are excluded from coverage:

A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw.

A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth .

Read Also: What Percentage Does Medicare Part A Cover

What Services Are Covered By Private Health

Dental services may be covered through either hospital or extras health insurance policies. Most extras policies subsidise general dental . However, major dental work and orthodontics generally require a higher level of extras cover.

Before commencing with any dental treatment, it can be a good idea to contact your private health insurer to find out what dental services are covered as part of your insurance policy. You can also confirm if you have any limits in the amount you can claim and if there is any waiting period for your specific treatment. Some private health policies will allow you to see specific dentists for a reduced or waived gap. However, it is a good idea to not only research the details of your policy carefully but ensure youre happy with their choice of dentist.

Its important to note that any dental surgeries that need to be done in hospital will require private hospital cover if you arent eligible for or would prefer not to use the public system. The types of surgeries requiring this type of cover could include wisdom tooth removal and dental implants.

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When Should You Get A Standalone Dental Plan

If youre not signing up for a Medicare Advantage plan that gives you unified coverage across medical and dental, a standalone dental plan is the next best way to get coverage.

You can purchase a plan directly from a private insurance company, and most let you sign up for dental insurance even if you dont have medical insurance through the company. This plan wont be connected to your other coverage through the Medicare program, but it can help you get cost-savings benefits so you get the dental services you need.

Benefits of standalone dental plans:

  • Choose the level of coverage you want, with plans ranging from basic or preventative coverage to plans that cover more extensive dental treatments.
  • Select the insurance company that has your preferred dentists in its network of providers without this choice influencing your medical plan.

Dental plans for seniors include Dental HMOs, which generally have lower monthly costs but only cover care from an in-network dentist. If youd rather have the flexibility to see any dentist, choose a Dental PPO plan that provides broader coverage but generally costs more each month.

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Additional Dental Coverage Options

For seniors who already have Medicare coverage, here are five ways to get additional dental coverage.

  • Choose A Medicare Plan That Has Dental Coverage. While the basic Medicare options dont cover dental care, you can sign up for Medicare plans that do. Several Advantage plans , like Part C, cover preventive services like exams and cleanings, basic services like fillings, extractions, and X-rays, and major services like root canals and crowns. Also, remember if youre choosing a Medicare plan to cover your dental needs, its important to think about what you need not just right now, but in the future. If you expect youll need dentures or partials in the years to come, be sure you have a plan that covers those.

  • Purchase Stand-alone Dental Insurance. One of the easiest ways to get dental insurance while you have Medicare is to simply purchase it. There are stand-alone dental insurance plans available where you pay a monthly premium just like any other insurance plan. These insurance plans require you to see an in-network dentist, but youll receive annual cleanings at no charge as partial coverage for dental work.

  • Join A Spouses Dental Plan. This isnt an option in a situation where two spouses are on Medicare, but its an option thats important to address because many people miss it. If you have a spouse who is employed and on a traditional insurance plan, theres a good chance you can be added to just their dental plan.

  • Enroll In Optional Dental Coverage

    Medicare Advantage Dental | Are “Free” Dental Benefits Worth It?

    Current Medicare Advantage-Prescription Drug Plan members can sign up using the Optional Supplemental Dental HMO or PPO plan enrollment form and send it to us at the address provided on the enrollment form.

    If you have any questions about applying for dental coverage, you can call to speak with a Blue Shield of California Medicare adviser. Hours of operation are 8 a.m. to 8 p.m. seven days a week, from October 1 through March 31, and 8 a.m. to 8 p.m., weekdays from April 1 through September 30.

    1The Optional Supplemental Dental HMO plan is not available to Blue Shield Enhanced , Blue Shield AdvantageOptimum Plan , Blue Shield AdvantageOptimum Plan 1 , Blue Shield TotalDual Plan , Blue Shield Inspire , Blue Shield Select , Blue Shield Inspire in Sacramento County and Blue Shield 65 Plus members in the San Luis Obispo and Santa Barbara Counties. Refer to the plan Summary of Benefits for additional information.

    2The Optional Supplemental Dental PPO plan is not available to Blue Shield AdvantageOptimum Plan , Blue Shield AdvantageOptimum Plan 1 , Blue Shield TotalDual Plan and Blue Shield Inspire members. Refer to the plan Summary of Benefits for additional information.

    3Dental providers in California are available through a contracted dental plan administrator. Network numbers are as of June 2022

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    Does Medicare Cover Vision And Dental

    Original Medicare does not cover routine dental or vision care. There are certain circumstances under which Original Medicare may provide some coverage for dental or vision care in an emergency setting or as part of surgery preparation.

    However, you may be able to receive routine dental and vision coverage by enrolling in a Medicare Advantage plan that includes dental and vision benefits.

    Why Is Dental Coverage Important

    Oral health is an important part of living a healthy life. If youre looking for Medicare dental coverage, some kinds of Medicare Advantage Plans may offer basic dental coverage, but not all. Original Medicare doesnt include dental.

    There are also plenty of standalone dental plans to consider. Shop carefully and make sure to read the details of any plan before you enroll.

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    How Can I Get Dental Vision And Hearing Coverage With My Medicare Supplement Plan

    Who is this for?

    If you have a Blue Cross Medicare Supplement or Legacy Medigap plan, this tells you how to get dental, vision and hearing coverage to go with your plan.

    Blue Cross Medicare Supplements do not cover dental, hearing or vision exams, or cleanings, or other items like cleanings, prescription lenses or hearing aids. For $15.25 a month you can the Dental Vision Hearing Package to enhance your Medicare supplement plan. The premium cost may be re-evaluated each year and is subject to change.

    When Do Wellcare Medicare Advantage Plans Pay For Dental Care

    Best Dental Insurance For Seniors On Medicare

    Wellcare sells Medicare Advantage plans, many of which may include dental coverage.

    Medicare Advantage plans like the ones offered by Wellcare provide all of the same benefits as Original Medicare , and most plans offer additional coverage for things Original Medicare doesnt cover. These additional benefits may include things like dental, vision, hearing, prescription drugs and more.

    While Wellcare Medicare Advantage plans that include dental benefits may cover a range of covered dental services, they do not typically cover dental implants.

    Some of the covered dental benefits you might find in a Wellcare Medicare Advantage plan may include some of the following dental care items and services.

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    Ways For People On Medicare To Get Dental Coverage

    Finding the right Medicare plan can be a tough task for someone over 65. There are a lot of options to choose from just considering basic coverage, and then youve got to decide if you want additional things covered like prescriptions.

    For the most part, Medicare gives seniors the medical care they need. Theres one major area, however, where many seniors actually arent covered their teeth. Medicare covers any dental care that results in a hospital stay, but routine dental procedures arent covered.

    The coverage most people know about, Original Medicare does not include basic things like dental examinations, yearly cleanings, crowns, fillings, or dentures. There are a few exceptions, like when a hospital stay is required, but youll pay out of pocket for anything tooth related. And for seniors who are already watching their income, paying out of pocket for these expenses may be impossible. Perhaps thats why almost 20 percent of seniors have untreated decay.

    Do Medicare Advantage Plans Provide Dental Benefits In Connecticut

    It is possible to get dental benefits in Connecticut by purchasing a Medicare Advantage plan. These are optional supplements that expand the coverage offered by traditional Medicare. In addition to getting access to a preapproved network of providers, you also get the benefit of low deductibles, out-of-pocket spending limits, and other cost-sharing measures. While the government reimburses the providers for services covered under traditional Medicare, the benefits offered under Medicare supplement plans are reimbursed by private insurers, such as UHC, Humana, and Aetna. In most cases, you will receive a red, white, and blue ID card for your traditional Medicare and a separate card for your supplement. In addition to vision and prescription drug coverage, most Medicare supplement plans also cover basic dental exams, routine cleanings, and standard dental X-rays. According to MedicareAdvantage.com, the average cost for a Medicare supplement is just over $400 per year. Since the dental benefits are relatively limited in scope, you may still face significant out-of-pocket expenses if you need a complex procedure or have multiple dental issues.

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    How Current Proposals Would Add A Dental Benefit To Medicare

    In the 116th Congress, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act , which among many provisions, provided for dental coverage under Part B of the Medicare program, starting in 2025 if enacted into law. Medicare would cover 80% of the cost of preventive services and basic treatments, and would phase up coverage for more major treatments, covering 10% of the cost in 2025, increasing 10 percentage points per year to 50% in 2029 and thereafter. The Congressional Budget Office estimated this benefit would cost almost $238 billion over 10 years . The recently reintroduced version of H.R. 3 does not include coverage for a dental benefit.

    Representative Doggett introduced the Medicare Dental, Vision, and Hearing Benefit Act in July 2021 that would provide dental coverage under Medicare Part B. In contrast to H.R.3, the proposal, according to a press release, would require no coinsurance for preventive services, and impose a 20% coinsurance for more extensive benefits, which is similar to how the Part B benefit is structured for physician and other outpatient services, and is lower than the 50% coinsurance typically charged by Medicare Advantage plans.

    Find Dental Plans For Medicare Near You

    How to Get Dental, Vision and Hearing Coverage with Medicare

    To find a dental plan near you, you should visit the websites of the companies offering Medicare Advantage plans to view the details of each plan. Many company websites also allow you to see if your dentist accepts the plan. If youre not sure where to start, consider talking to a broker or consultant. Good resources include the State Health Insurance Assistance Program at 877-839-2675 or call Medicare at 800-MEDICARE to get answers to questions not answered in your research.

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    Other Options For Dental Coverage Or Discounts

    First, look to your company or spouses employer if either of you is still working. Half the people 65 or older who had dental coverage were employees, spouses of employees or retirees, according to the National Poll on Healthy Aging. In some cases, employers may offer retirees access to a dental benefits plan or provide a referral to a company that offers benefits, says Richards of Delta Dental.

    Second, you may be able to get dental coverage or a dental discount program through a Medigap policy. In 2020, about 1 in 8 Medicare beneficiaries were enrolled in Medigap plans with additional dental, vision or hearing benefits, according to the Commonwealth Fund, a century-old foundation that focuses on better health care. Some dental programs offer 30 percent to 40 percent discounts for services such as cleanings, crowns, exams and fillings using eligible dentists and have no copays, coverage limits or waiting periods.

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    How Do I Get Medicare To Pay For Dentures

    Original Medicare does not cover dentures. In general, Medicare does not cover any routine dental care, including cleanings or check-ups, and never pays for dentures. It may cover the cost of teeth extraction before an inpatient procedure, but will not cover the cost of dentures after the procedure.

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