Who Can Help Compare Medicare Plans
If you are considering a Medicare Advantage plan and want to compare the different plans, check out The Centers for Medicare & Medicaid Services Five-Star Rating System. The CMS star rating measures Medicare Advantage programs on factors like: management of chronic conditions, availability of care, overall experience and complaints of members, customer service, and drug pricing. These star ratings are updated by CMS every year.
If you need more personalized assistance with comparing Medicare plans and deciding what insurance makes the most sense for you, you can contact your local State Health Insurance Program . Each jurisdiction has a SHIP, offering trusted, unbiased one on one counseling and assistance to navigate the complexities of Medicare.
The bottom line when it comes to Medicare and Medicare Advantage is that you really need to do your research. You may appreciate some of the additional coverage perks that Medicare Advantage offers, but its important to know what you may be giving up too. Whatever option you choose, the good news is, its not irreversible. You can always switch during the next open enrollment period.
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What Is Medicare Advantage
Medicare Advantage is an alternative to original Medicare and offers the same basic coverage. Some plans may also offer additional benefits, such as dental, hearing, and vision coverage. Some plans also include prescription drug coverage.
Private health insurance companies offer these plans, though a person will continue to pay their Medicare Part B premium, which is $148.50 in 2021. There may also be an additional Medicare Advantage plan premium, depending on the individual plan a person chooses.
Do Kaiser Medicare Plans Include Dental Coverage
Depending on the type of Kaiser Medicare plan you choose, you may receive coverage for preventive dental services such as exams, cleanings and X-rays every six months. Dental services may require a small copayment.
More advanced dental services may also be covered at a reduced rate and may include diagnostic and restorative services, endodontics, periodontics, extractions and prosthodontics.
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What Does Original Medicare Mean For Dental Care
The short answer is that Original Medicare doesnt cover most dental care, including cleanings and fillings. According to the Kaiser Family Foundation, almost two-thirds of Medicare beneficiaries do not have dental coverage. Some dental services can be covered by Medicare Part A .
Medicare, for example, would cover the cost of a jaw reconstruction after an accident injury or tooth extractions required prior to radiation treatment. An oral exam would be covered before any procedure such as a kidney transplant, heart valve replacement or kidney transplant. However, you wont be covered for any treatment that results from the exam. If the exam was performed by a hospital dentist, Medicare Part A would cover it. Medicare Part B would cover you if you were examined by a doctor.
Part A would cover your hospital costs if you need emergency or complex treatment. However, the actual dental care would not be covered. Similarly, Medicare Supplement Insurance plans will not cover routine dental care.
What To Do If A Plan Doesnt Cover Dental Services
If a Medicare Advantage plan doesnt cover dental work, the beneficiary will have to pay all of the costs for their dental visit, unless they have subscribed to an additional plan that their provider offers to fill the gaps of Medicare Advantage. Those whose dental work isnt covered may want to search for another Medicare provider or call their current provider to inquire about alternate plans.
Not all Medicare Advantage plans cover dental services, but many do. Before scheduling a trip to the dentists office, its a good idea to review dental plan coverage.
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Best For Special Needs: Cigna
Cigna
If you have special dental needs as a senior on Medicare, then Cigna is a good choice. They offer special needs plans and an increased range of services for customers who need them.
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Only available in 23 states
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Dental coverage only available with some plans
We chose Cigna as best for special needs because of their personalized plan offerings. While other Medicare Advantage Plans limit coverage to individuals with special health conditions or care needs, Cigna offers special needs plans that include access to a wider range of specialists, along with regular health assessment .
Depending on your health care needs, Cigna offers an increased range of services, whether that is more intensive treatments, personalized care treatments, or more individual specialist attention.
Based on a review of Cignas Model of Care, the National Committee for Quality Assurance has approved Cigna to operate as a Special Needs Plan through 2021.
Cigna offers a health risk assessment that can be used to develop personalized care plans with Cigna Medicare Advantage Plan enrollees and their primary care doctor. The HRA also helps match each enrollee with the health and wellness services that best fit their needs.
Originally founded in 1792 as the Insurance Company of North America, Cigna is now an American worldwide health services organization. They have a full range of plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
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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Typical Senior Dental Costs
According to the Kaiser Family Foundation, nearly one in five Medicare beneficiaries who visited a dentist within the last year spent more than $1,000 in dental care in 2016. The following are some examples of dental costs:
- Basic cleaning: $70 $200
- X-rays from $20 to $250
- Dental exam: $50-150
- Composite resin fillings: $90 to $255.
- Root canal cost: $300-$2,000
- Nonsurgical tooth extraction: $75-300
- Tooth extraction , $150-$650
According to a University of Michigan survey, 69% of those aged 50-64 who delayed seeing a dentist said that cost was their primary concern. Dental insurance can help keep out-of-pocket costs down and make expenses more predictable.
Medicare Part B Dental Benefits
On the other hand, if the physician conducts the examination needed prior to kidney transplant or heart valve replacement, the CMS states that Part B benefits will apply.
However, when it comes to Medicare Part B, there are two specific sets of services that it will not cover.
The first involves services used to care, treat, remove, or replace teeth to structures supporting the teeth. For example, this can include pulling teeth prior to getting dentures.
The second set of services Medicare Part B wont cover also include those related to the teeth and their supporting structures, unless those services are needed to effectively treat a non-dental condition.
In this type of situation, the dental service must be performed at the same time as the covered service in order for Medicare to pay its portion. It must also be performed by the same healthcare professional who performed the covered service, whether that person is a physician or dentist.
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Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
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Medicare Dental Coverage Under Medicare Advantage
If youd like to get more comprehensive dental coverage under Medicare, you might want to consider a Medicare Advantage plan, available under the Medicare Part C program. Offered through Medicare-contracted private insurance companies, these plans are required to offer at least the same coverage as Original Medicare in other words, a Medicare Advantage plan would cover dental care under the same situations as Original Medicare. In addition, many Medicare Advantage plans offer additional benefits such as routine dental or vision care, wellness programs, and prescription drug coverage.
While Medicare dental benefits may vary by plan, some of the services you may be covered under a Medicare Advantage plan may include routine dental exams, cleanings, X-rays, fillings, crowns, root canals, and more. Some Medicare Advantage plans may require you to use dentists in provider networks when receiving care, or you may have the option to use non-network dentists but at a higher cost-sharing level you can check with the specific plan youre considering for more details.
Keep in mind that there may be certain costs related to your dental coverage, including deductibles, copayments, and or/coinsurance. In addition, youll need to keep paying your Part B premium if you enroll in a Medicare Advantage plan, along with any monthly premium required for your plan.
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 .
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Im Retired Is Dental Insurance Worth It
Dental health has a direct impact on physical health. Studies have shown there is a link in seniors between gum disease and heart disease¹³. Overall, researchers have found that seniors with healthy teeth and gums are less likely to suffer from heart attacks and other serious health complications.
While people of all ages can benefit from dental insurance, dental insurance for adults over 65 can supplement your Medicare coverage and help you pay for preventive care, as well as major dental services, which is important since adults over 65 are more likely to have tooth decay, gum disease, tooth loss, and oral cancer.¹
Almost two-thirds of people on Medicare dont have any dental coverage, dental insurance can help reduce the cost of keeping your teeth healthy. If youre currently on Medicare and you dont have any dental insurance coverage yet, consider purchasing individual dental insurance.
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Original Medicare Dental Coverage
Original Medicare, Part A and B, does not cover routine dental care, including:
- Cleanings and oral exams
- Bridges
- Dental appliances, including dentures or dental plates
There are a few exceptions to this. Medicare Part A may cover certain dental services performed in a hospital if its a necessary part of a covered service. For example, if you need a preliminary oral examination before a surgery or organ transplant or if you need reconstructive jaw surgery, you may be covered for these dental procedures because the care is related to another service that Medicare does cover. You may also be covered for extractions if theyre needed to prepare your mouth for radiation for oral cancer. If you receive these services as an outpatient, youd be covered under Part B.
If you need inpatient emergency hospital care because of a complication from a dental procedure, Part A will cover your inpatient hospital treatment, even if the dental services arent covered.
Keep in mind that even if Original Medicare covers a specific dental service, you may not be covered for post-treatment dental services once the specific issue has been treated. So, for example, in the case of Medicare covering reconstructive jaw surgery, it may not continue paying for dental care after that operation.
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What Are Dental Discount Plans
A number of private companies offer discount plans that allow consumers to pay a discounted rate for basic dental services. These plans are different than traditional insurance. Instead of paying a monthly or annual premium, you pay a low enrollment and membership fee. You still pay the dentist directly for the service but at a pre-negotiated, discounted rate.
In addition to their low cost, discount plans offer several other advantages over traditional insurance:
- Most plans do not have age limits or exclusions for pre-existing conditions.
- You receive full benefits immediately.
- You dont have to worry about paperwork, deductibles, copays, or coinsurance obligations.
- You are free to change dentists at any point.
- You are not limited to a certain number of office visits per year.
Discount plans may not cover as much as traditional insurance when it comes to complex procedures, so standalone insurance may be a better option if you need extensive dental work. Discount plans are, however, a good option for individuals who are in good oral health and who only need basic preventative care or basic services, including: X-rays, exams, cleanings, fillings, root canals, extractions, dentures, and crowns.
Many popular discount plans, such as DentRite, also offer discounts for prescriptions as well as vision, hearing, and other wellness services.
What Dental Services Are Covered By Medicare
When it comes to Medicare and dental coverage, only Medicare Advantage Plans may offer dental coverage and not all of them do. This coverage is typically basic and could include:
- Teeth cleaning
- Fillings
- And possibly more
Make sure to review all details of any Medicare Advantage Plan before you enroll. Plans may differ based on the insurance company and even your location. Dental coverage often comes with limits on how many services are covered in a plan year, maximum cost allowances, and more.
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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.
Medicare Advantage Dental Policies
One exception to the dental exclusions under Original Medicares parts A and B is Medicare Advantage. Commonly referred to as Part C, these types of policies are offered by private insurance companies and are intended to cover all of the same basic expenses participants receive under the Original Medicare plan.
Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
Additionally, these plans can be:
- HMOs
- PFFS Plans
- SNP
The type of plan chosen depends on what benefits youd like to receive, the cost of the plan, and any coinsurance or copayments that would apply.
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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 Biden’s 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 it’s an important health care issue. About 47% of those on Medicare don’t 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.
