How To Get Help With Your Dental Coverage Under Medicare
As you can see, Original Medicare covers very little in the way of dental care. If you have a Medigap plan, youll need to purchase a separate dental plan to get benefits for dental care.
If you have Medicare Advantage, some plans do include dental benefits, but not all. Whether you want to enroll in a separate stand-alone dental plan or a Medicare Advantage plan that includes dental benefits, we can help!
Give us a call today or fill out our convenient online rate form to get connected with the best rates in your area.
Coverage Of Routine Dental Care Wasnt Built Into Medicare
Medicare was never designed to include routine dental care Medicares coverage of dental expenses is limited to situations where the dental treatment is integral to other medical treatment . Although, as noted in this brief from the Center for Medicare Advocacy, CMS has some flexibility when it comes to how the rules are interpreted.
While health insurance plans generally pick up the tab for large medical bills, its rare to find dental coverage that doesnt leave enrollees on the hook for significant bills if they need extensive dental work. This is generally true across a wide range of plan types, including Medicare Advantage dental coverage, stand-alone dental plans, and group dental plans for employees and retirees. Dental plans commonly have benefit maximums of $1,000 or $2,000 per year, and a single root canal can cost upwards of $1,500, while an implant can be as much as $7,500 per tooth.
But some coverage is better than nothing. Even with low benefit maximums, people who have dental insurance are more likely to receive routine preventive dental care, and are less likely to have untreated dental problems that get worse over time.
What About Medicare Advantage
Medicare Advantage, or Medicare Part C, is a form of Medicare that private insurance plans offer. Although plans vary depending on healthcare provider network, geographical area, and the private insurer, some provide coverage for routine dental care.
Medicare Advantage combines parts A and B, as well as some elements of Part D. This part accounts for prescription drug cover and some other services.
The types of plan available may depend on the area in which a person lives. Many Medicare Advantage plans involve visiting a particular physician or group of hospitals that has contracts with their Medicare Advantage plan.
The same may also be true for the dentists in a persons area. A person may need to see an in-network provider to receive coverage for their dental services.
Anyone considering switching to a Medicare Advantage plan for improved dental cover should look at participating providers in their area, as well as which dental services the plan will fund.
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Best Medicare Alternatives For Dental
Does Medicare cover dental? Unfortunately, Original Medicare does not offer dental benefits. This lack of coverage can be frustrating, as your oral health is an essential part of your overall well being. While Original Medicare does not cover dental services and you are able to get dental coverage with a Part C plan, you do have additional options to find dental care.
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Do Aetna Dental Savings Plans Cover Dental Implants
Aetna also offers dental savings plans. With some dental savings plans, you can receive discounts for a range of dental services, including dental implants, from any dentist who accepts the plan.
Dental savings plans can often help pay for cosmetic services and can be used for pre-existing conditions, such as teeth that were missing before the plan took effect.
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Medicare Open Enrollment 2021
The Medicare Open Enrollment period occurs every year from October 15 to December 7. Medicare Advantage plan Open Enrollment occurs each year from January 1 to March 31. During this time, you are able to switch from 1 Medicare Advantage plan to another or you can switch from a Medicare Advantage plan back to Original Medicare. During this period, you are also able to join a Medicare drug plan if you are already enrolled in an Original Medicare plan or switch from one drug plan to another.
Original Medicare And Dental Coverage
Original Medicare consists of two parts, Part A and Part B . In general, neither parts cover routine dental care. One expectation in which you may be covered for dental services under Original Medicare is if you suffered a traumatic injury to the jaw, teeth, or mouth that required hospitalization. In this instance, you may be covered under Part A for any reconstructive surgery and for your hospital stay. For all other dental services like routine cleaning, extractions, fillings, etc. you will have to pay out of pocket.
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Whats The Best Dental Coverage For You
If youre on Medicare and need a dental plan but parts A and B dont cover it, there are several options. It all depends on your personal situation. Maybe youd like the all-encompassing coverage of a Medicare Advantage plan. Perhaps thats more than you need.
If all youre looking for is straight dental coverage, you can choose among options like a dental savings plan, prepaid dental like an HMO or even straight dental insurance like a PPO. Even if youre on Medicare, you may still be able to afford dental insurance coverage because dental procedures are typically less expensive than medical ones.
How Do You Get Dental Coverage If Medicare Doesnt Include It
If youre on a Medicare plan thats working for you and doesnt offer dental coverage, there are other options you may consider:
- Buy a separate or standalone dental plan from a private insurance company. There are many types of dental plans to choose from, usually with affordable monthly premiums. Basic dental plans may offer you coverage for preventive dental care with lower monthly premiums. Other plans may provide more dental coverage for a little higher premium. Standalone dental plans usually include deductibles, copays, and coinsurance.
- Look for an affordable walk-in dental clinic in your area. Depending on where you live and what kind of dental services you need, you may be able to find affordable dental care even if it means paying out-of-pocket.
- Check with your state department of health. They may have information on where you can get low-cost dental services.
- Have a local dental school or university program nearby? You can contact them to see if they offer any free or low-cost dental clinics.
- Before age 65, you can consider opening a Health Savings Account if you have a high deductible health plan. Once you enroll in Medicare you can no longer contribute to the fund, but you can certainly use what youve saved to help pay for covered expenses, including eligible dental care.
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Ways To Get Dental Coverage With Medicare
If you are on Medicare and want to have dental coverage, you do still have some options, which are itemized and explained below:
Get The Dental Coverage You Need With Clover Health
At Clover Health, we understand the vital role that dental health plays in your overall health. Thats why many of our Medicare Advantage plans offer both preventive and comprehensive dental coverage as well as other benefits and services that you expect and deserve.
We make the following commitment to you its what we call the Clover Health Promise:
We do whats best for you.
We treat you like a person, not a policy.
Were here when you need us.
Wed be happy to help you find the right Clover Health Medicare Advantage plan. Feel free to call us at 1-800-836-6890 to speak with one of our Medicare specialists from 8 am to 8 pm local time, seven days a week.* Or contact us using our online form and we’ll get back to you.
Source: CDC.gov and ADA.com
- 8 am8 pm local time, 7 days/week*
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Types Of Medicare Advantage Plans
- Health Maintenance Organization Plans
- Preferred Provider Organization Plans
- Private Fee-for-Service Plans
- Special Needs Plans
Like any insurance policy, Medicare Advantage has premiums, deductibles and copays. Some plans offer out-of-network coverage at a higher cost. Once you enroll in a Medicare Advantage plan, youll no longer use regular Medicare.
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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Medicare Advantage And Dental Coverage
Paying out of pocket for dental care can be very costly especially for those living on a limited income. In fact, according to the National Poll on Healthy Aging, about half of adults age 6580 reported that they do not have dental insurance. Luckily there is a solution with a Medicare Advantage plan.
Medicare Advantage, also known as Part C, provides all the same benefits as Original Medicare plus more. Private insurance carriers offer plans that are approved by Medicare. Often these plans include additional benefits like:
Where Can I Buy A Medicare Advantage Plan That Is Right For Me
If you decide to shop for a Medicare Advantage plan , you can do it the hard way or the easy way.
The Hard Way
The hard way to shop for a Medicare Advantage plan that is right for you is to call every company that offers a plan in your area , speak with a representative, take notes, and then compare with all other companies.
However, when you speak with a company representative, remember that they work for the company and not for you.
The Easy Way
The easy way to shop for a Medicare Advantage plan is to speak with an independent insurance professional who specializes in Medicare like the Medicare Solutions Team.
The Medicare Solutions Team represents many of the highly-rated private insurance companies that offer Medicare Advantage plans. These specialists represent many companies but arent employed by any of them.
This means that your Medicare Solutions Team member will submit your case to all of their carriers simultaneously and then deliver a Medicare Advantage solution that is right for your needs and your budget.
We can Help!
Talk to one of our licensed Medicare supplement agents about the options available to you in your area.
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Does Medicare Plan B Cover Dental
Part B does cover dental but it only covers the dental expenses that are a necessary part of another covered service. Such procedures could include oral exams in anticipation of a kidney transplant or reconstruction of teeth following an accident. It doesn’t cover the regular care, treatment, removal, or replacement of teeth. For example, the plan does not cover routine dental services such as cleaning, dentures, crowns, or fillings.
Whereas Part A does pay for inpatient hospital care if you need to have an emergency or complicated dental procedure, it doesnt cover dental care. On the other hand, some Medicare Advantage plans do include coverage for dental care.
Each plan has different costs and rules for how these benefits can be used. Therefore, for regular or preventative dental treatments, it’s better for Medicare beneficiaries to invest in separate dental plans. It’s also advisable to consider your future needs and family dental history before deciding on a plan. Outside of Medicare, there are also dental coverage plans such as standalone dental insurance, dental discount groups, or the Program of All-Inclusive Care for the Elderly .
Does Medicare Cover Dental Expenses
As an independent Medicare specialist, does Medicare cover dental expenses is in the top 10 of our Medicare frequently asked questions.
Medicare can be confusing when it comes to understanding whats covered and what isnt covered. If youre focused on taking care of your oral health, you should first understand if dental expenses are covered by Medicare.
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The good news is Medicare beneficiaries have options when it comes to finding the best coverage that will meet their individual circumstances and budget.
Were here to help you make the best decision for obtaining dental care coverage and explain when Medicare covers dental expenses.
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When Can Aetna Medicare Advantage Plans Pay For Dental Implants
One major factor that can determine if your dental implants are covered by an Aetna Medicare Advantage plan is whether the implants are considered cosmetic or medically necessary. If cosmetic, some plans might not cover the implants. But if the dental implants are considered medically necessary, they may be covered.
Some plans may include an annual allowance that you can use for things like dental implants. If your Aetna Medicare plan has this type of annual allowance, you may be able to apply for reimbursement for your dental implants.
Depending on what type of Medicare Advantage plan you have, it might have a network of participating dentists. You may be able to pay less in out-of-pocket costs by visiting these providers, if network restrictions apply to your dental implants coverage.
How Can Medicare Beneficiaries Get Dental Insurance
Because Medicare Advantage plans are required to provide at least the same amount of coverage as Original Medicare , these plans also cover the procedures mentioned above. Some Medicare Advantage plans may include more comprehensive dental coverage. If dental benefits are included, this may include routine dental services not covered under Original Medicare. Benefits vary from plan to plan, so check with the specific Medicare Advantage plan if youre interested in learning more about dental coverage. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare.
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Services Excluded Under Part B
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 .
Does Medicare Coverage Include Vision And Dental Care
When it comes to vision and dental care, things can get a bit confusing concerning what coverage you have with your Medicare benefits. Because Original Medicare Part A and Part B provide coverage for care that is medically necessary, they do not help pay for routine vision and dental care such as regular examinations, teeth cleanings or fillings, tooth extraction, eyeglasses or contact lenses.
But not all vision and dental care is routine. Your Original Medicare insurance , or Medicare Advantage Plan , may offer coverage for certain preventive and diagnostic exams, treatments, surgeries, or some supplies. It is important to know what coverage you have regarding your vision and dental care. Having all the information about your Medicare benefits is essential for making the best decisions regarding your health care.How does Medicare cover vision care?
If you require vision care as a medical emergency or due to traumatic injury, Original Medicare Part A covers that care if you are treated as an inpatient in a hospital. You must be formally admitted as an inpatient at a Medicare-approved facility.
Medicare recipients who have Original Medicare Part B have coverage for the following preventive and diagnostic eye exams:
- Eye examinations for diabetics to test for diabetic retinopathy one time per year.
- Glaucoma tests once every 12 months if you are considered at high risk for glaucoma. People at high risk are:
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