Still Unsure About Which Medicare Plan Is Right For You
Winding your way through the maze of Medicare coverage options can be confusing. This is particularly the case if you may require coverage for services that are not typically provided for through Medicare Part A and Part B.
But having a health care plan that is flexible and comprehensive can make a big difference in terms of how your needs are covered, as well as how much you may be required to pay yourself.
If you are still not sure about which of the many Medicare plan options are right for you, we can help. Even if you are already enrolled in a Medicare plan, the coverage options and/or the premiums may change over time. Because of that, it can be beneficial to review the various coverage alternatives that are available to you.
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.
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.
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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.
Which Medicare Advantage Plans Cover Dental Implants
Plans vary widely, so careful research is essential to understand the availability and extent of coverage for dental implants. Kaiser Permanentes Senior Advantage Plus plan includes basic and major restorative dental services. After meeting a $50 dental deductible, enrollees pay 50% coinsurance up to a $1,250 annual benefit maximum.
Best Online Tools: Humana
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 fingerprint sign-in for 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. These are the kinds of useful website features that made Humana our pick for 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.
With some of their Medicare Advantage plans, Humana offers an option for additional dental coverage. For example, if you are located in Dallas, Texas, and enroll in the Humana Gold Choice PFFS plan, you have a $45 copay for in-network dentist visits and a $50 copay for an out-of-network dentist for Medicare-covered dental services. For an additional premium you can enroll in Humanas MyOption Dental – High DEN838, which includes benefits for preventive, basic, and major services at both in-network and out-of-network dentists.
How Much Does Medicare Advantage Dental Coverage Cost
You generally will pay a copayment or coinsurance for most Medicare Advantage dental coverage, such as 50% coinsurance or a $50 copayment. If you have a Medicare Advantage plan that only covers Medicare covered benefits you may have to pay for routine services, such as cleanings and fillings 100% out of pocket. Medicare Advantage plans with more comprehensive dental coverage may have higher monthly premiums.
You also may have to use a provider within the plans network in order to be covered. There also may be an annual limit on Medicare Advantage dental coverage, for example, $1,000.
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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.
DentaQuest: best customer satisfaction
Remember to compare plans based on the waiting period, and some policies may not cover major services until youve 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 arent the best fit for everyone, but we recommend them as one of the five ways to get a cheap dental cleaning without insurance.
Does Medicare Cover Dentures
En español | Original Medicare does not cover dentures or other dental devices, such as partial plates.
In general, Medicare does not cover dental services. However, Medicare Advantage plans policies sold through private insurance companies that provide all the original Part A and Part B Medicare coverage often include dental work among their suite of additional benefits, and that may include coverage for dentures.
Medicare Advantage plans may carry additional premiums, above what you pay for original Medicare. If you have Medicare Advantage, check with your plan provider about dental benefits.
You also might be able to access dental benefits if you have a Medicare Supplemental Insurance policy . These plans, also sold by private insurers, cover some out-of-pocket costs for original Medicare benefits.
Some companies that sell them offer their Medigap clients add-on options for dental coverage or discounts on out-of-pocket costs for oral care. Ask your Medigap provider about available deals.
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What Other Benefits Besides Dental Can I Get With Medicare Advantage
In addition to coverage for dentures, Medicare Advantage may offer other benefits, like vision coverage or hearing coverage including for hearing aids. Most plans include prescription drug coverage as well. The coverage provided by each individual Medicare Advantage plan varies, but if you are looking for one that specifically covers full or partial dentures or other items related to tooth loss, chances are there is one available near you. It is important to review your options carefully.
Medicare Advantage plans commonly offer the following popular coverage options:
- Dental care
- Hearing care
- Vision care
- Prescription coverage
Dental Benefits Provided By Medicare Advantage Plans
Routine dental coverage is available with most Medicare Advantage plans, with a $0 copay* for preventive services with in-network dentists. Plans will offer different levels of dental carefrom preventive and diagnostic services only, to more comprehensive dental coverage. In some areas, for an additional monthly premium, you can change your plan to get dental coverage through a Dental Rider.
Medicare Advantage Plans With Dental Care Benefits
Another option for Medicare beneficiaries is to enroll in a Medicare Advantage plan that offers routine dental care coverage.
A Medicare Advantage plan provides all the same coverage as Original Medicare .
In addition to covering the same benefits as Original Medicare, some Medicare Advantage plans may offer additional benefits such as:
- Prescription drug coverage
The dental coverage afforded by some Medicare Advantage plans can provide patients with benefits such as access to networks of qualified dentists while offering price protection in the form of deductibles, cost-sharing measures and out-of-pocket spending limits.
Plus, many Medicare Advantage plans also offer coverage for prescription drugs, so some of the medications needed for oral care may be covered under the plan as well.
In 2018, the average premium paid for a Medicare Advantage plan was around $35 per month, or roughly $420 per year.4 When you consider the annual costs of receiving dental care without insurance, you may find that a Medicare Advantage plan with dental benefits could fit your situation and health care needs.
Find a Medicare Advantage plan with dental coverage
Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.
Why Dental Care Is Important For Your Health
When Medicare beneficiaries forego dental care, they may be putting more than just their teeth at risk.
Numerous studies have found and confirmed direct connections between oral health and overall health.6 Just a few of the complications that can be associated with poor dental hygiene include:
- Erectile dysfunction
Your mouth is full of bacteria, most of which is harmless when proper dental care is practiced. But when oral health is compromised, so too is the mouths ability to serve as a gatekeeper to the rest of the body.
A weakened level of oral health can mean more harmful bacteria is able to pass through and enter the body, leading to other health complications.
Unhealthy teeth can also make it harder to eat a nutritious diet, as chewing fruits or meat can become difficult with weakened teeth. This can lead to increasingly poor diet choices, which in turn can factor into multiple other health concerns.
Poor dental health can also lead to social anxiety and isolation because of feelings of embarrassment when speaking or smiling.
Medicare beneficiaries may want to consider their dental coverage options in order to help ensure their overall health is protected.
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Best Dental Insurance For Seniors On Medicare Of 2022
- Best Customer Service: Kaiser Permanente
- Best Online Tools: Humana
- Best for Potential New Offerings: WellCare
- Best for Special Needs: Cigna
- Coverage Limit : $1,000 to $3,000
- Providers In Network: 1,300,000
United Healthcare is our top overall pick for dental insurance for seniors on Medicare. They offer Medicare Advantage plans with an expansive network and flexible premiums.
Limited plan options depending on your location
Not all Advantage plans include dental coverage
United Healthcare, founded in 1974, was chosen as best overall based on its popularity and its affiliation with the American Association of Retired People . In 2021, 22 million people were enrolled in Medicare Advantage plans nationwide. Of those 22 million people, United Healthcare insured the largest share of them, 27%.
More than 74% of Medicare beneficiaries have access to at least one United Healthcare plan. Also, United Healthcare services ranked fourth in overall customer service in a 2021 J.D. Power study .
Their full range of plans has premiums ranging from $0 to over $100 each month, depending on your needs and location. If you choose United Healthcare, you’ll also receive access to additional AARP programs and services such as discounts on shopping and travel, savings on home and auto insurance, and free financial advice.
What Dental Care Does Medicare Part A Cover
Medicare Part A won’t cover dental services such as cleaning, fillings, root canals, crowns, extractions or dentures.
However, if you have an emergency or complicated dental procedure where you need to go to the hospital, Medicare Part A can cover your hospital care. This could include jaw surgery, tooth extractions before cancer radiation treatments, splints for facial fractures, an oral exam before a kidney transplant or other major treatments.
In these situations where you need hospital treatment for your jaw, mouth or teeth, we recommend that you check the billing codes for each service to confirm your coverage.
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What Medicare Plan Covers Dentures
A full set of adult teeth amounts to 32 teeth â that includes the wisdom teeth. According to the National Institute of Dental and Craniofacial Research, 27.27% of seniors over age 65 have no teeth remaining. Youâre not alone!
Dentures are prosthetic devices designed to replace missing teeth. Traditional dentures are removable â these are often the dentures you see in movies that are always falling out and embarrassing the older folks at the dinner table.
However, technology is always advancing, and there are now many types of denture designs. Dean Cosmetic Dentistry Center explains that implant-supported dentures canât slip off the gums, and they donât require adhesive to stay in place. They attach to dental implants, and you can even remove them for cleaning. There are also other options, like mini dental implants, which are minimally invasive and are less expensive.
Either way, there are fantastic options thatâll give you back your smile! The question is, at what price?
What Does Medicare Advantage Dental Cover
Medicare Advantage Plan dental coverage varies by plan. It can be anywhere from as little as two cleanings per year to an annual allowance of up to $2,000, Pruemm says. Medicare Advantage dental coverage usually includes cleanings, routine x-rays, extractions and fillings. However, a prior authorization or advance approval is usually required. Other services may also be covered, but often for an additional premium.
Plans will also often limit the number of services covered. For example, you may be eligible for only one periodontal exam every three years, according to KFF.
Some plans will let you go to your own dental provider, but others may have a network of dental providers you must stay within in order to receive their benefits, Pruemm says.
You can read the Explanation of Benefits included in the plan documents to see what benefits a specific plan offers.
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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 .
What Are Medicare Advantage Plans
Medicare Advantage plans are optional and expand on the coverage offered by traditional Medicare. Unlike basic Medicare, which is sponsored and subsidized by the government, Medicare Advantage supplements are offered and reimbursed by private insurers. These plans normally require beneficiaries to utilize network providers and tend to have low deductibles, low premiums, out-of-pocket spending limits, and other cost-sharing and price protection measures. Many of the most popular plans, such as Aetna, UHC, and Humana, include dental, vision, and prescription drug benefits. Since these plans are separate from traditional Medicare, beneficiaries normally receive a separate ID card from the insurer. Since the average annual premium for a Medicare Advantage supplement is usually very low, they are within reach for many seniors. The benefits, however, are normally limited to basic preventative services, such as exams, standard X-rays, and cleanings. Even with a Medicare supplement, you could still face significant out-of-pocket expenses if you need extensive dental work or a more complex procedure.
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