Does Medicare Cover Dental Video & Blog
One of the most common questions we receive is, Does Medicare cover dental procedures or eye exams?
The short answer is that Medicare does not cover most dental care. This includes cleanings, fillings, dentures, extractions and so on. It also does not cover eye exams for eyeglasses or contact lenses.
However, Medicare Part A, inpatient coverage, may cover certain dental services that are related to your inpatient hospital stay. For example, it is not uncommon for your doctor to require an oral exam and treatment before an organ transplant or heart surgery. This may also include emergency or complex dental procedures related to facial cancer, reconstructive surgery and so on. That is covered by Medicare.
Regarding vision, keep in mind that Medicare will cover eye diseases or conditions like cataracts and glaucoma. But it does not cover corrective vision.
Because Medicare does not cover basic dental care and has very limited dental benefits, stand-alone dental, vision and hearing insurance coverage is very popular among those on Medicare. But also very misunderstood.
In this video, I will review how you can get dental insurance coverage and how you compare one plan versus another. You will want to be able to sort through the plans that are available to you and identify the best value. So, grab a pen and paper and join me as we guide you through dental plans that improve upon your Medicare.
Find A Medicare Advantage Plan That Covers Dental And Vision Care
Medicare Advantage plans can come in a variety of types, such as HMOs or PPOs.
The type of plan you have may affect which dental or vision providers you can visit in your plan network. Before enrolling in a plan, its wise to check the plans network participants to see if your favorite dentist or optometrist accepts the plan.
Compare Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
1 Fugelsten Biniek, J. et al. . Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where youve seen coverage of Christians research and reports:
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare Advantage And Dental Coverage
The Medicare Advantage program offers you a way to get your Original Medicare benefits through a private, Medicare-approved insurance company.
Some Medicare Advantage plans cover routine dental services. Medicare Advantage dental coverage is generally the only way to get dental services covered under Medicare.
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How Do I Enroll In A Humana Medicare Advantage Plan
To enroll in a Humana Medicare Advantage plan, youll need to find out which plans are available in your area.
You can see what policies are open to you by visiting Humanas website. Enter your ZIP code and select your county to see a list of the Humana Medicare Advantage plans in your area.
To learn more about Humana Medicare Advantage plans, contact a customer service representative at 800-457-4708.
You can also request to meet with a Humana representative by filling out a contact form.
How Medicare Advantage Dental Coverage Compares To Affordable Care Act Marketplace Coverage
As context for assessing the scope of dental benefits offered to Medicare Advantage enrollees, we reviewed dental coverage available to those who purchase dental coverage through the ACA Marketplaces. Adults purchasing plans through the ACA Marketplace may have dental coverage as part of their medical plan, or may choose to purchase separate stand-alone dental coverage. Among stand-alone dental plans available to adults on HealthCare.gov in 2021 , 100% cover routine preventive dental services , 97% cover basic dental care , and 81% cover major dental care . Unlike the analysis of Medicare Advantage plans, the data on the ACA Marketplace is not enrollment-weighted.
Like Medicare Advantage plans, most plans have little to no cost sharing for preventive services. For adult routine dental coverage, most plans charge no coinsurance , followed by no coinsurance after meeting the dental deductible . The median dental deductible for an individual is $50. For adult basic dental care, the most common cost sharing amount is 50% coinsurance after meeting the dental deductible .
Most plans on the ACA Marketplace have an annual limit the plan will pay toward covered services, typically ranging from $1,000 to $2,000. For stand-alone dental coverage, premiums vary slightly depending on the age of the enrollee. For an adult age 40, the average premium in 2021 is $290 per year, and ranges from $97 per year to $780 per year.
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Option : Standalone Dental Plan For Seniors
Some health insurers offer dental coverage for seniors as standalone dental plans. These add-on plans are a great choice for dental coverage if you only have Original Medicare or if you have a Medicare Supplement plan.
When selecting a plan, compare coverage details and plan specifics because there is a broad range of policies on access and restrictions. Each plan will specify how much it covers for preventative dental care, basic services or major services. Most plans have a network of providers, and checking this list can make sure you have access to your preferred dentist.
The best dental insurance plans for seniors are from DentaQuest, Aetna and Humana.
DentaQuest: best customer satisfaction
Remember to compare plans based on the waiting period, and some policies may not cover major services until you’ve had the policy for several months. Humana is a great option if you need dental care immediately because most plans have no waiting period for major services like root canals, crowns and dentures.
Many providers may also offer an alternative to dental insurance called a dental discount program. These dental network programs aren’t the best fit for everyone, but we recommend them as one of the five ways to get a cheap dental cleaning without insurance.
How To Get Dental Coverage
To ensure routine dental care like cleanings, examinations, extractions, and other services are covered by insurance, you will need to enroll in an additional plan. There are some choices for receiving dental coverage:
Medicare Advantage PlansMedicare Advantage plans include the same coverage provided by Part A and Part B. Some of these plans cover additional services as well, such as dental care. Private insurance companies offer Medicare Advantage plans, which vary in terms of costs and coverage. It is essential to compare plans carefully to ensure the dental care you need will be covered.
Stand-Alone Dental PlansYou can consider a stand-alone dental plan from a private insurance company as well. Coverage, premiums, and deductibles can vary, based on the plan you choose.
Medicare Supplement Insurance PlansMedicare Supplement insurance plans, such as Plan F, do not include coverage for routine dental care. They are designed to cover out-of-pocket expenses for Original Medicare. Plan F covers all cost-sharing services for Plan A and Plan B. If you have Plan F, you will need to enroll in separate dental coverage.
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Find A Medigap Plan To Help Cover Your Medicare Costs
When you receive health care services that are covered by Medicare, you typically face costs such as a Medicare deductibles and coinsurance. These costs can add up quickly over time for covered services, which are in addition to your costs for any services you receive that aren’t covered by Medicare.
Learn more about common procedures that medicare covers.
A Medigap plan can help make your health care costs more predictable, which can help you budget for your dental and vision care needs as a Medicare beneficiary.
Learn more about Medicare Supplement plans available near you and compare available plans to find the right fit for you.
Medicare Supplement Insurance can help cover your out-of-pocket Medicare costs.
What Is The Best Dental Insurance For Seniors On Medicare
Determining which dental insurance plan is best for you requires a consideration of your specific needs and preferences. It all boils down to what aspects of dental coverage are most important to you, be it the cost, network size or benefits that address specific dental issues that concern you most. Start by narrowing your plan options based on your geography and budget. Next, you can compare various plans customer satisfaction ratings, coverage limits and more. Its also worth researching the top dental insurance providers before enrolling in coverage.
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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.
Do All Medicare Advantage Plans Cover Dental Services
No â although many Medicare Advantage plans cover routine dental care, not all do. That� � âs why it may be a good idea for you to compare Medicare Advantage plans. That way, you can see which Medicare Advantage plans cover dental services and other benefits that are important to you. For example, if routine vision and hearing care are important to you, you can look for such coverage when you compare plans.
One easy and quick way to compare Medicare Advantage plans â with no obligation to enroll â is to use eHealthâs plan comparison tool. All you need to do to get started is enter your zip code on this page.
You may have to pay a deductible and/or coinsurance or copayment for these services in Medicare Advantage plans with dental coverage.
Itâs important to keep in mind that Medicare Advantage plans are offered by private insurance companies contracted with Medicare. These private insurance companies must cover everything that Original Medicare covers, and might offer additional coverage as well. Routine dental services would be considered additional coverage.
Medicare Advantage dental services may vary from plan to plan. As you browse through Medicare Advantage plan descriptions, look under the âdental servicesâ section. If it says âMedicare-covered benefitsâ you may not get any coverage beyond what Original Medicare covers, which does not include routine care.
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Why Its Important To Find Good Dental Coverage As You Get Older
Good dental care is vital to maintaining your overall health and wellness. Poor dental hygiene has been linked to chronic inflammation, diabetes, heart conditions, and other serious health difficulties.
And studies have also shown that people sometimes neglect their dental care as they get older, often because dental care can be expensive.
The National Institute of Dental and Craniofacial Research estimates that 23 percent of seniors havent had a dental exam in the past 5 years. That figure is highest among African American and Hispanic people and among those who have lower incomes.
One nationally representative poll conducted in 2017 revealed that cost was the most common reason people didnt seek professional help in caring for their teeth. Yet good preventive care can help you avoid more serious dental problems in the future.
For that reason, its a good idea to consider an affordable plan thatll cover the dental services you need as you get older.
How Could Medicare Dental Coverage Change In 2022
In 2021, a bill was introduced in the House to add dental coverage to Medicare Part B.
Known as the Medicare Dental, Vision, and Hearing Benefit Act, the idea has support from the White House as part of President Bidens Build Back Better agenda. Specifically, the fiscal year 2022 budget proposal for the U.S. government indicates the intent for improving access to dental, hearing, and vision coverage in Medicare.
This is not the first time it has been proposed to offer dental coverage to Medicare beneficiaries, and its an important health care issue. About 47% of those on Medicare dont have dental coverage.
The legislative process will determine if Medicare benefits are expanded in 2022 to include dental. However, there is political incentive because adding dental, vision and hearing is cheaper than other proposed Medicare extensions, such as adding nursing home coverage.
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How Much Does Medicare Pay For Vision Care
Medicare pays 80% of the Medicare-approved cost of vision services, procedures and supplies such as eyewear. If Original Medicare is your only insurance, youll pay the remaining 20% after meeting your deductible. When vision services are performed in an outpatient hospital setting, youll also pay a separate hospital copay. The copay amount varies but will never exceed the Medicare Part A deductible amount, which is $1,556 for 2022.
Medicare-participating providers and suppliers agree to accept payment that is typically lower than their regular fee. When you use a participating provider, the amount you owe is based on that lower amount. This reduces your final payment and saves you money.
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Dental Coverage With Original Medicare Part A And Part B
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.
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Best Online Tools: Humana
Humana is our top pick for a dental plan with robust online tools. They have a handy mobile app and allow users to list medications, view claims, and even earn rewards for healthy actions.
Robust selection of helpful online tools
SilverSneakers fitness program
Website interface can be confusing
Not all plans come with dental coverage
Humana offers a wide variety of online tools helpful to Medicare Advantage Plan enrollees. Humanas RXMentor helps enrollees keep a complete, up-to-date list of their medications. Their MyHumana app offers access to ID Cards, drug pricing, claims, and in-network providers. Their Go365 program and app allow you to earn, track, and redeem points for completing healthy actions. Both the app and Go365 are accessed using two-factor authentication to keep your accounts secure. These are the kinds of useful website features that made Humana our pick for the best online tools.
Humana also offers SilverSneakers, a health and fitness program for seniors that includes gym access, classes, and the SilverSneakers Go fitness app for tracking and scheduling activities.
Founded in 1961, Humana offers a full range of Medicare Advantage plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
What Does Medicare Cover Related To Dental Implants
There are other expenses related to dental implants, such as exams, x-rays to determine the state of your gums and teeth roots, and tooth extractions. If your MA plan has dental benefits, routine exams and x-rays are generally covered at least in part. Depending on your plan, tooth extractions may be partially covered as well. Crowns are sometimes covered, but if a plan excludes dental implants, the crowns associated with them are typically excluded as well.
The majority of dental implant procedures are done on an outpatient basis. Your MA dental plan may partially cover costs associated with the procedures, such as anesthetic or nitrous oxide.
The best way to determine if your MA plan with dental benefits pays for these other expenses related to dental implants is to talk directly to your dental provider/biller who works with insurance and understands which codes to apply to your claim.
If you have an MA plan that would pay for dentures as an alternative to implants, it is worth exploring whether or not some of those benefits could be applied to your dental implant costs.
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.
Does Medicare Offer Dental Coverage
No, Original Medicare, which is managed by the federal government, does not cover most routine dental care, dental procedures or supplies. People insured by Medicare have to pay the full cost of cleanings, fillings, tooth extractions and dentures.
However, Medicare Part Awhich covers hospital stays, care in skilled nursing facilities and hospice carepays for certain medical dental services provided during a hospital stay. For example, if you suffered a traumatic injury to your teeth or jaw, Medicare would cover hospitalization and procedures medically necessary for recovery.
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