Options For Dental Coverage
Some Medicare Advantage plans offer extra benefits that Original Medicare doesnt cover. That may include coverage for preventive dental exams, cleanings, X-rays, fillings, anesthesia, dentures and crowns. These added benefits will vary by plan and most likely require deductibles and copays, so be sure to check out the details before you decide.
You can also purchase a dental-only insurance plan. You’ll have to pay a monthly premium and satisfy deductibles and copays, but the cost may be offset by lower out-of-pocket fees. Most of these dental plans require that you see an in-network dentist. Some plans let you go to any dentist , but you may have to pay more for their services.
A dental discount plan may be worth considering if you dont have dental insurance. These discount plans arent dental insurance. They are a type of membership, similar to a warehouse club, but rather than getting bargains on food or clothing, you get discounted prices on dental services.
This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult your doctor to determine what is right for you.
Some links on this page may take you to Humana non-Medicare product or service pages or to a different website.
Why You Need A Dental Plan For Seniors
As you age, you may be at increased risk for certain dental conditions, according to the American Dental Association. Dental conditions associated with aging include dry mouth, dental caries and periodontitis, a serious gum infection. Physical and cognitive impairments may also make home oral health care difficult for seniors, exacerbating dental problems. You may wish to have a Medicare dental plan to avoid paying out-of-pocket for dental treatment.
Medicare Advantage Plans May Cover Oral Surgery And May Cover Other Dental Care
By law, Medicare Advantage plans must provide the same minimum benefits as Medicare Part A and Part B, with the exception of hospice care, which you still receive from Medicare Part A. This means that qualified oral surgery is covered by a Medicare Advantage plan in the same way that it is by Medicare Part A and Part B.
Some Medicare Advantage plans may also provide coverage for routine dental services such as dental exams, fillings, tooth extractions, dentures and more.
Find Medicare Advantage plans that help cover oral surgery
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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 you’ve seen coverage of Christian’s 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 has neither reviewed nor endorsed this information.
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Best Dental Insurance For Seniors On Medicare Of 2021
- 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 2019, 22 million people were enrolled in Medicare Advantage plans nationwide. Of those 22 million people, United Healthcare insured the largest share of them, 26%.
More than 82% of Medicare beneficiaries have access to at least one United Healthcare plan. Also, United Healthcare services ranked fourth in overall customer service in a 2020 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.
Does Medicare Cover Dental Work
Unfortunately, there are no Medicare dentists, and Original Medicare doesnt pay for most dental care, procedures, or supplies. If you need to have a filling, root canal, crown, dentures, or a cleaning, Medicare wont cover the cost youll have to pay for it yourself or find other coverage.
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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.
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.
Vision Care Lags With Blind Spots In Insurance Coverage
But a big part is politics. On the campaign trail, Biden promised to lower Medicare’s eligibility age from 65 to 60. “Medicare for All” advocates like Senate Budget Committee Chair Bernie Sanders, I-Vt., pledged to try to do the same, and lowering the eligibility age is included in the outline Schumer shared with Senate Democrats as an option.
But lowering the eligibility age is vehemently opposed by hospitals and other health providers, who fear they will lose money if people currently covered by higher-paying private insurance are covered by Medicare instead. That makes benefits expansion the much easier choice for Congress.
That is not saying it will happen. The Congressional Budget Office says the vision, hearing and dental benefits included in a bill passed by the House in 2019 would have cost an estimated $358 billion over 10 years. But this is the closest the benefits have gotten to enactment since Medicare’s inception.
Kaiser Health News is a national, editorially independent newsroom and program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.
Medicare May Cover Oral Surgery If It Is Medically Necessary
Oral surgery involves procedures performed on the bones, nerves or tissue of the jaw or mouth. When such a procedure is considered medically necessary and is performed by a Medicare-participating doctor or surgeon, it may be covered by Medicare.
Medically necessary is defined as a treatment or service that is required in order to treat a specific injury, illness, disease or condition.
- For example, if you suffer an injury that results in facial or jaw fractures and are admitted as a hospital inpatient, Medicare Part A may cover some of the costs of your hospitalization and surgery costs.
- If your oral surgery is performed in an outpatient setting, Medicare Part B may cover the surgery if it is medically necessary and is part of a Medicare-covered service.
It is important to keep in mind that Medicare will not cover oral surgery that is solely intended to treat your teeth, such as the installation of bridges, crowns or dentures.
If you require this type of surgery, you will likely pay the full cost of your treatment unless you have dental insurance or a Medicare Advantage plan that offers dental benefits.
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Does Medicare Cover Invisible Aligners
Invisible aligners like Smile Direct Club help straighten teeth but arent as noticeable as braces. Medicare wont cover invisible aligners. But, some insurance companies usually treat aligners the same as braces. If your dental insurance includes orthodontic work, it will typically cover aligners.
With that said, it may be hard to find insurance that includes adult orthodontic coverage. If you do, you can expect to pay a percentage of the cost. Another option is to buy into a dental discount program that offers a discount on aligners.
Do Medicare Advantage And Medicare Supplement Plans Cover Dental
Sometimes, Medicare Advantage plans are approved by the federal government and sold by private insurance companies. These plans often offer services not covered by Original Medicare, such as dental, vision and hearing coverage, says Christian Worstell, a North Carolina-based licensed insurance agent. Enrollees might pay an extra premium for these benefits. However, not all Medicare Advantage plans offer dental coverage, so its important to read your plans details carefully.
Medicare Supplement plansalso known as Medigap plansdont directly cover dental, but they pick up some of the out-of-pocket costs like copayments, coinsurance and deductibles, says Worstell. Plus, many insurance companies that sell Medigap plans offer you the option of adding a dental or vision package for an additional premium, he adds. They dont all do that, but a lot of carriers these days are now offering it.
Medicare Advantage plans tend to be the best way to get dental coverage, but you can also buy a separate dental plan offered by a private insurance company, says Worstells.
My advice to all incoming Medicare beneficiaries is to ask yourself, How do I plan to pay for my dental care? Do you have the funds to pay for it out of pocket? If not, you should strongly consider a Medicare Advantage plan or a standalone dental insurance plan from a Medicare carrier or insurance carrier, advises Worstells.
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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
- 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.
Additional Dental Coverage Options
For seniors who already have Medicare coverage, here are five ways to get additional dental coverage.
Choose A Medicare Plan That Has Dental Coverage. While the basic Medicare options dont cover dental care, you can sign up for Medicare plans that do. Several Advantage plans , like Part C, cover preventive services like exams and cleanings, basic services like fillings, extractions, and X-rays, and major services like root canals and crowns. Also, remember if youre choosing a Medicare plan to cover your dental needs, its important to think about what you need not just right now, but in the future. If you expect youll need dentures or partials in the years to come, be sure you have a plan that covers those.
Purchase Stand-alone Dental Insurance. One of the easiest ways to get dental insurance while you have Medicare is to simply purchase it. There are stand-alone dental insurance plans available where you pay a monthly premium just like any other insurance plan. These insurance plans require you to see an in-network dentist, but youll receive annual cleanings at no charge as partial coverage for dental work.
Join A Spouses Dental Plan. This isnt an option in a situation where two spouses are on Medicare, but its an option thats important to address because many people miss it. If you have a spouse who is employed and on a traditional insurance plan, theres a good chance you can be added to just their dental plan.
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Individuals Under Age 21
EPSDT is Medicaid’s comprehensive child health program. The program’s focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state’s Medicaid program.
Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.
Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
Medicare Dental Coverage Under The Pace Program
PACE is a joint Medicare and Medicaid program that provides health-care services for people living in a community so that they can delay institutional or nursing home-care for as long as possible. PACE covers all services covered under Medicare and Medicaid and if you enroll in the program, youll get all of your Medicare coverage through your PACE organization as long as your health-care team determines theyre necessary for your care. In addition, PACE may include certain benefits beyond the Medicare program, such as dental services.
You may be eligible if youre 55 years or older and enrolled in Medicare, Medicaid, or both programs . You must also live in the service area of a PACE program be able to live safely in a community environment and need a nursing home-level of care . To learn more about PACE and see if youre eligible, visit Medicare.gov.
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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
So Where Should You Go For Dental Coverage
Medicare Advantage plans, which are private health insurance plans, cover everything that Medicare Parts A and B cover, and some of them also offer dental benefits. Many cover routine preventive care, such as cleanings, X-rays, and regular exams, either partially or in full. You may also find coverage for things like extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.
Like other private health insurance plans, Medicare Advantage plans come in a variety of types, including HMO and PPO plans, as well as private fee-for-service plans. And Medicare Advantage plans generally have a monthly premium in addition to the premium for Medicare Part B, which is $144.60 in 2020.
But there are some disadvantages to Medicare Advantage plans, such as a more limited list of approved doctors and hospitals. So make sure you understand what youre getting. You will also need to use a dentist in the Medicare Advantage network, so if you have a dentist you like, check to see if they are in the network. Compare costs and benefits for plans in your area before buying. You can search for a plan using Medicares Plan Finder.
Otherwise, if you stick with Medicare as your primary insurance, youll need to get separate dental insurance or pay for dental care out of pocket. You can check the costs of private dental plans using a broker site online.
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