Does Medicare Cover Dental Care
When it comes to Medicare, you have two main options. You can either enroll in Original Medicare or a Medicare Advantage plan. You cannot have both. Understanding the difference is important when it comes to dental care.
In 1997, Medicare Part C was created. It was initially called Medicare+Choice, but its name was changed to Medicare Advantage in 2003.
These plans cover everything Original Medicare does, but they are overseen by insurance companies rather than the federal government. The insurance companies are allowed to offer additional services, known as supplemental benefits, above and beyond what Original Medicare covers.
Original Medicare covers dental care, but in limited circumstances. Medicare Advantage plans, on the other hand, can offer dental care as a supplemental benefit.
Depending on the plan you choose, this can include a wider range of services, including but not limited to routine dental cleanings, bridges, crowns, dentures, fillings, root canals, tooth extractions, and X-rays. Most plans set a cap on how much they would pay for dental care annually.
Some Medicare Advantage Plans May Cover Dental And Vision Care
Many Medicare Advantage plans include routine dental and vision coverage.
Medicare Advantage plans are required by law to provide all of the same basic benefits as Medicare Part A and Part B. Many plans may also offer extra benefits that Original Medicare doesn’t cover, such as dental and vision care.
Medicare Advantage plans that cover dental and vision care may cover services such as:
- Routine eye exams
- An allowance for prescription glasses and contact lenses
- Routine dental exams
- An allowance for dentures
Dental Coverage Utilization And Out
Nearly 24 million people, or about half of all Medicare beneficiaries , did not have any form of dental coverage in 2019 .
Figure 1: Nearly half of all people on Medicare have no dental coverage
The remaining Medicare beneficiaries have access to dental coverage through Medicare Advantage plans, Medicaid, and private plans, including employer-sponsored retiree plans and individually purchased plans.
In 2019, 29% of all Medicare beneficiaries had access to some dental coverage through Medicare Advantage plans . Another 16% had coverage through private plans. About 11% of Medicare beneficiaries had access to dental coverage through Medicaid . With the rise of Medicare Advantage enrollment, a growing share of Medicare beneficiaries have access to some dental coverage through their Medicare Advantage plan, so the share of all Medicare beneficiaries with some dental coverage would likely be higher in 2021.
Lack of dental care can exacerbate chronic medical conditions, such as diabetes and cardiovascular disease, contribute to delayed diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits.1 Limited or no dental coverage and cost concerns contribute to Medicare beneficiaries foregoing routine and other dental procedures.
Utilization. In 2018, half of Medicare beneficiaries did not have a dental visit with even higher rates reported among those who are Black or Hispanic .
Read Also: Does Kaiser Permanente Take Medicare
How Do I Enroll In Medicare Advantage To Get Dental Coverage
Medicare Part C is sold through private insurance companies. Enrollment in Traditional Medicare is a prerequisite for purchasing Medicare Advantage plans. Then, applicants can get quotes from supplemental Medicare providers in their area. Bear in mind that supplemental providers dont cover all areas of the country, so its important to find ones that cover the correct location. For those who split their time between two locations, its a good idea to look for plans that cover both areas or enroll in plans from providers in both locations.
Medicare Advantage Dental Benefits
Medicare Advantage plans may provide extra benefits that are not covered under traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits may be covered using rebate dollars. Plans can also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans, have access to some dental coverage. The majority of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans generally includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. More extensive benefits cover a range of services, including restorative services , endodontics , periodontics , prosthodontics , and oral surgery.
The Scope of Covered Dental Benefits Varies Across Medicare Advantage Plans
Virtually all Medicare Advantage enrollees in plans that offer access to dental benefits , have access to preventive services, including oral exams , cleanings , and x-rays , although fewer enrollees have access to fluoride treatment .
like other dental benefits, coverage for dentures varies across plans
Medicare Advantage Plans That Offer Dental Benefits Typically Have an Annual Dollar Cap on Dental Coverage
Preventive Services Are Often Covered Without Cost Sharing For More Extensive Dental Services, 50% Coinsurance and Caps Are the Norm
You May Like: How Many Parts Does Medicare Have
Ready To Find Out More About Coverage For Oral Surgery With Medicare
If you have questions about your insurance coverage, we encourage you to contact Orange County Center. Our dentist in Lake Forest is always available to answer any questions you have and can help point you in the right direction. We accept many insurance plans and always work with our patients to ensure they can receive the dental care they need.
To schedule an appointment, or to speak to one of our team members, contact Orange County Center and we will be happy to assist you.
Hearing Exams And Hearing Aids
Medicare doesn’t cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare Part B covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. All people with Part B are covered.
Your costs in Original Medicare:
- You pay 100% for routine exams and hearing aids.
- You pay 20% of the Medicare-approved amount for the doctor’s services for covered exams, and the Part B deductible applies.
- In a hospital outpatient setting, you also pay the hospital a copayment.
Note: Some Medicare Advantage plans offer extra hearing benefits. Be sure to contact the plan for more information.
What Does Dental Coverage Cost
Generally, the cost of Medicare Advantage plans and dental coverage specifically in cases where theres an extra premium involved vary based on factors like your age and where you live. Some have a $0 monthly premium while others cost more. In eastern Pennsylvania, for example, Medicare Advantage plan premiums range from $0 to $302 a month. In the Los Angeles area, they range from $0 to $397 a month.
Low-cost Medicare Advantage plans that dont include an extra monthly premium for dental coverage typically include basic dental services, such as checkups and cleanings, says Worstell.
The more expensive plans include coverage of more advanced dental services like extractions and dentures and other things more relevant to older patients.
Legislative Help On The Way
The bipartisan Action for Dental Health Act of 2018 has been applauded by consumer advocates and the dental industry as a step towards improving Americans oral health via a grant-based program, but its also controversial in that much of its focus is on improving education and awareness surrounding oral health, as opposed to actually increasing access to care .
And high-quality dental insurance for adults remains elusive. Bills are routinely introduced in Congress to add dental care to Medicares list of covered services, but have thus far not been successful.
Most recently, Senator Ben Cardin introduced the Medicare Dental Benefit Act of 2021 . The legislation, which Cardin has introduced several years in a row, calls for Medicare Part B to cover services that are necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions. These would include things like cleanings, exams, x-rays, fillings, extractions, root canals, crowns, dentures, emergency dental care, and other necessary services related to dental and oral health.
S.97 has not advanced in the 2021 session, but you can contact your elected representatives to urge them to support this legislation if dental coverage for Medicare beneficiaries is important to you.
Read Also: Is Upmc For You Medicare Or Medicaid
How To Sign Up For Supplemental Medicare
Supplemental Medicare plans dont have open enrollment periods like traditional Medicare does. Those eligible can sign up for plans at any time.
Use Medicares Plan Finder to locate supplemental plans in the desired area. Some applicants may be able to sign up online through the plans website. If that is not possible, they can contact the plan provider for a paper enrollment form, fill it out and return it to the plan provider. All plans offer a paper enrollment option. The plans provider will ask for a Medicare number and the date the Part A or Part B coverage started, which is found on the Medicaid card.
Once an individual finds a suitable plan, they can call the provider for more information. Those with more general questions can call Medicare at 1-800-MEDICARE .
Learn More About Medicare Dental Coverage
If youre interested in Medicare dental coverage, I can find Medicare Advantage plan options that may offer routine dental benefits. To learn more about me, see my photo below and click the View profile link read more about my background. You can schedule a one-on-one phone call or request an email from me with more plan information find both of those links below as well. If you want to compare plan options now, click the Compare Plans button on this page.
This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Don’t Miss: Does Medicare Cover Ice Therapy Machines
Medicare Options That Do Not Cover Dental Services
Original Medicare does not cover dental procedures like dental implants. Medicare Part B coverage is notorious for not offering much in the form of dental care, except in very rare circumstances.
Likewise, Medicare Supplements do not cover dental implants, as their coverage is the same as Original Medicare.
For dental services and dental implant coverage, youâre going to have to look at Medicare Advantage options.
Medicare Advantage Plans That Cover Dental Implants
Thereâs a popular American myth that George Washington had wooden teeth. Thank goodness dentistry has evolved â that is, until youâre faced with the bill for dental implants and suddenly those wooden dentures donât look nearly as bad!
Today, weâre going to explore your Medicare dental implant options and show you how to find a dental plan that wonât give you splinters.
Need Medicare or retirement planning help? The Medicare Allies team specializes in Medicare health insurance as well as retirement planning. Call us today at 833-801-7999 for personalized help.
Recommended Reading: How Do You File For Medicare
How Much Does Oral Surgery Cost With Medicare
Medicare Part A requires a $1,408 deductible for each benefit period. Once the deductible is met, there is no coinsurance required for the first 60 days of a hospital stay. If you require oral surgery this type of procedure is typically outpatient. In order to receive coverage, you must enroll in Medicare Part B. Medicare Part B has an annual deductible of $198 per year before oral surgery costs will be covered. Typically, patients are responsible for 20 percent of the approved surgery. Medicare Advantage plans may cover routine procedures and oral surgery.
If you have questions about Medicare coverage and what plans you should enroll in, we encourage you to speak to a licensed Medicare agent to discuss your coverage. Our team at Orange County Center can also provide information, and help answer any questions you may have.
Medicare Advantage Vision Coverage
A Medicare Advantage plan with vision benefits may cover things like:
- Routine eye exams
- Eyeglasses and contact lenses
- Upgraded frames
Some Medicare Advantage plans may even offer coverage for specific retailers, such as frames from Warby Parker.
Check with your plan carrier to learn more about the terms of your Medicare Advantage plan vision coverage.
Also Check: Is Dental Care Included In Medicare
Does Medicare Cover An Abscess Tooth
An abscess is an infection in your gum or at the root of a tooth. If you develop an abscess, your dentist may perform a root canal treatment or pull the tooth. The dentist may also prescribe antibiotics. Many dental policies cover root canal treatments, but youll have to pay part of the cost.
Your Part D plan should pay for antibiotics your dentist prescribes. If the infection spreads and becomes more severe, Part B will cover a doctors care, and Part A will cover hospitalization.
Does Medicare Cover Oral Exams
No, Medicare wont cover an oral exam. But, some companies sell Medicare dental plans either alone or bundled with Advantage.
Each company is different, and some only carry benefits. Even the most basic plans should cover preventive services like dental exams and x-rays. Sometimes youll have a copay.
Your insurance may pay the full cost of an exam, or you may have to pay part of the bill. Your plan may also require you to choose a primary dentist or use the dentists in the network.
If you need a dental exam because youre having a kidney transplant or heart valve replacement, Part B may cover your exam, but it wont cover any dental work you need.
Do Medicare Advantage Plans Cover Dental And Vision
Medicare Advantage plans can offer coverage for dental and vision health items in addition to also offering the same coverage as Original Medicare. Most also include prescription drug coverage as well as other benefits such as hearing health coverage and gym memberships.
Medicare Advantage plans are offered by private insurance companies. The plans available to you depend on where you live. What specific dental and vision items are covered and how much they cost will vary from plan to plan.
Does Part C Cover Dental
Some Advantage plans include dental insurance, and others dont. Coverage can vary. Some plans cover only standard services, and others cover a wide range of dental procedures.
Recommended Reading: Does Medicare Offer Dental And Vision
Does Medicare Cover Diabetic Retinopathy
Those with diabetes carry the risk of developing diabetic retinopathy, which is a complication of diabetes that damages blood vessels in the retina and affects vision.
An annual exam for diabetic retinopathy can be covered by Medicare Part B if you have diabetes.
If qualified for any of the above coverage, you will pay 20 percent Part B coinsurance for services and items and the Part B annual deductible applies.
Medicare Advantage Dental Coverage
A Medicare Advantage plan with dental coverage may offer benefits that could include:
- Routine dental exams
The specific coverage offered by your plan may not include all of the items listed above. Check with your plan carrier to learn more about the terms of your Medicare Advantage plan dental coverage.
Read Also: Is It Mandatory To Take Medicare At 65
Direct Member Reimbursement Allowance
With Aetna MA plans that include a direct member reimbursement allowance, members are given a set amount of money to spend each year on dental care. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna® for reimbursement.
With a direct member reimbursement allowance, youre given a set amount of money to spend each year on dental care.
You can see any licensed dental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs .
One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance.
Direct member reimbursement allowance: How to get reimbursed for dental care
How Does Medicare Advantage Dental Coverage Work
Medicare Advantage plans are the primary method for dental coverage under Medicare.
Whats usually covered:
- Tooth extractions
Medicare Advantage are bundled plans that combine add-on benefits such as dental or vision with Original Medicare and additional cost-sharing for medical needs. About 94% of Medicare Advantage plans offer the option for dental coverage. However, sometimes there is an additional fee to include dental coverage in your plan.
For example, the standard Medicare Advantage plan from Kaiser Permanente does’t include dental care, but if you upgrade to the Medicare Advantage Plus plan, you’ll get dental, vision and hearing coverage.
The level of dental coverage with Medicare Advantage plans varies. Some have an annual payout limit, such as only contributing $1,500 to your dental care each year. Other plans could have coverage specifications on the number of cleanings per year or denture coverage.
Don’t Miss: What Are The Qualifications For Medicare