Does Medicare Pay For Dental Work

How Does Medicare Advantage Dental Coverage Work

Medicare Advantage plans are the primary method for dental coverage under Medicare.

Whatâs 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.

How Much Does A Medicare Advantage Plan With Dental Coverage Cost Out

Typically, copayment or coinsurance for most Medicare Advantage Plan dental coverage, such as 50% coinsurance or a $50 copayment. Also, many plans cap the annual coverage amount. That being said, plans are different between providers and even between plans offered by the same provider. You should check the costs associated with your dental coverage before committing to a plan.

Does Medicare Cover Anything Dental

Although there is no primary coverage of dental care in Medicare, there is some limited insurance through Medicare Part A, which is hospital insurance. Medicare Part A will cover some dental procedures that happen in a hospital stay. For instance, if youre in a car wreck that damages your jaw and you go to the hospital, Medicare would cover any reconstruction of your jaw.

Medicare may also cover the following types of things:

• A dental exam in a hospital before a kidney transplant or heart valve replacement
• Dental services related to radiation treatment for some jaw-related diseases
• Dental splints and wiring needed after jaw surgery
• Jaw reconstruction if you have surgery to remove a tumor from your face

But if you need a complex dental surgery that has to be done in a hospital, Medicare would cover your hospital stay, but not the dental surgery.

Keep in mind that even if Medicare covers a procedure like the ones listed above, it wont cover any related dental care that might follow from something that happened in the hospital.

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How Much Does A Medicare Advantage Plan Typically Cost

According to the Centers for Medicare & Medicaid Services, the average Medicare Advantage monthly premium is lower in 2022 at $19 per month , although the monthly premiums for a Medicare Advantage Plan can range from $0 to over $100. There are also out-of-pocket costs such as copayments and coinsurance. For some plans, out-of-pocket costs can also be impacted by going to doctors who are out of network.

Some plans have a yearly limit on your out-of-pocket costs for all medical services. For example, if you live in Dallas, Texas:

• The United Healthcare AARP Medicare Advantage has a $0 monthly premium and a $3,900 out-of-pocket maximum
• The HumanaChoice PPO has a $10 monthly premium and a $6,700 out-of-pocket maximum
• The Cigna-HealthSpring Preferred has a $0 monthly premium and a $5,500 out-of-pocket maximum

While you might be attracted to the perceived lower price, be sure to check the coverage to make sure that you are getting the care you want and need, without incurring additional costs that may offset the upfront savings.

Prices For Removable Dental Bridges & Related Insights

Removable dental bridges are one of the more affordable options, though they typically are not as sturdy or as comfortable as fixed dental bridges. Temporary or removable dental bridges may cost anywhere from $300 to $2,500¹. Acrylic partial dentures or flippers are typically the most affordable type of removable dental bridges¹.

If youre looking to replace a missing tooth, you have options, whether you choose a removable dental bridge, a fixed dental bridge, or an implant.Weve compiled a list of resources to help you learn more about how to replace missing teeth and how to help pay for the cost of dental treatment.

• Dental insurance can help you pay for dental treatment, but it comes at a cost. Learn how much is dental insurance.

• Dental implants are another excellent way of filling in missing teeth. Learn how dental insurance covers dental implants.

• Visiting an in-network dentist could help you save on the cost of dental bridges. Learn more about visiting an in-network dentist.

• Looking for dental insurance to help you save on the cost of dental bridges? Learn where to buy dental insurance online.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentists office.

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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.

What Type Of Dental Care Is Not Covered By Original Medicare

Original Medicare doesnât cover most types of routine dental care, including:

• Teeth cleanings
• Dental plates or other devices

Thatâs because when Medicare was established in 1965, the goal was to cover higher-cost, rarer types of health services such as surgeries, says Shain. Low-cost, more routine care wasnât part of what Original Medicare was designed to do, he says.

And even though you can supplement your Medicare coverage with a Medigap policy, that policy doesnât usually cover dental services either.

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How Can You Get Dental Care Covered

Original Medicare may have limited dental benefits, but you still have plenty of ways to get help paying for your care. And itâs worth staying on top of dental visits. Untreated gum disease can increase your risk for a range of serious conditions, including heart disease. Plus, certain conditions, such as diabetes and osteoporosis, can impact your oral health.

Medicare Advantage : If you want an insurance plan that covers dental services such as cleanings, fillings, or tooth extractions, you might want to consider Medicare Advantage. These plans often offer extra benefits such as dental, vision, and hearing services. According to the KFF, about 94% of people enrolled in Medicare Advantage plans had access to dental care.

Dental insurance: If either you or your spouse is still employed, you may be eligible to join the employerâs group dental insurance. If you buy a health plan under the Affordable Care Act, some of them include dental coverage, or you can purchase dental coverage separately.11]

Dental discount plan: Think of this as a membership program that offers discounted dental services. Hereâs how it usually works: Every year, youâll pay a fee that gives you access to a network of dentists and dental specialists who charge members discounted rates for exams, cleanings, fillings, and more.

Ready to get started? Find a plan that fits your budget and covers your doctor and prescription medications now.â¯â¯

Traditional Dental Coverage Is Not The Only Option For Seniors

If you dont have dental insurance coverage through an employer, a Medicare Advantage plan, or a stand-alone plan, and you cant afford to get one, theres another good option. Its the dental savings plan, often called discount dental. Its not insurance, and its not meant to be. Its a guaranteed discount, typically in the range of 40-60 percent, on all of the common treatments you need.Cigna.com, Discount Dental Programs, Accessed November 17, 2021

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Oral Health Problems And Organ Transplantation

The primary oral health issues for recipients of solid organ transplants are related to the drug therapy they must take to control graft rejection. This immunosuppressive therapy limits their ability to fight infections. Posttransplant infections can lead to very serious consequences including hospitalization, loss of the grafted organ, return to dialysis, retransplantation, or death. Thus, as people are evaluated before, during, and after transplantation, a central goal is to identify and eliminate existing infections and obvious potential sources of infection. These include infections associated with the mouth, although there is no direct evidence of serious infections linked specifically to oral sources . Some transplant centers will not operate on a patient with an active oral infection.

People with suppressed immunological function are vulnerable to several kinds of bacterial, viral, and fungal infectious agents that may be harbored in the mouth and elsewhere in the body. Many organisms that do not normally create problems in healthy people are a threat to those with suppressed immune systems. For example, a transient, typically asymptomatic bacteremia often occurs following various dental treatments, especially those involving the gums. This condition is of no concern in the patient with a fully functioning immune system but may be dangerous in the severely immunosuppressed transplant recipient.

Sign Up For A Dental Savings Plan

These noninsurance dental plans negotiate discounts ranging from 10 to 60 percent on dental costs. You pay a small monthly fee to join, and you get the discounts as long as you use a dentist that accepts the plan. Search for plans in your area at DentalPlans.com.

Join today and save 43% off the standard annual rate. Get instant access to discounts, programs, services, and the information you need to benefit every area of your life.

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Medicare Supplement Dental Insurance

If you need a supplement to your Medicare dental care to help cover costs, ask your dentist if they offer a dental savings plan. You can also purchase a supplemental dental insurance policy. To pursue either of these options, talk with your dentist and call your preferred insurance provider to learn about all of your options.

Also, check out our article that talks about affordable dental insurance for seniors for more information on finding low-cost dental care if you are 65 years or older.

To recap, the following video provides a clear summary of Medicare dental coverage and what services are included:

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Pick The Right Medicare Advantage Plan

While original Medicare and Medigap plans do not pay for most dental work, many Medicare Advantage plans offer some type of dental coverage. Benefits vary, but many plans pay for preventative care such as oral exams, cleanings and x-rays, and some cover a portion of the cost of expensive procedures such as crowns, bridges and root canals.

AARP

• Your Teeth, Your Health

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Dental Crisis In United States

Nearly half of Medicare beneficiaries have no dental insurance at all, and nearly half of all Medicare beneficiaries have not seen a dentist in the last year. Thats worrisome not just for oral health, but also for overall health. Theres a significant link between untreated dental disease and various other systemic ailments, including heart disease and diabetes.

Oral cancer is seven times more likely to be diagnosed in people over age 65, and routine dental check-ups are an excellent means of detecting oral cancer.

About one out of six Americans age 65 or older indicated that they hadnt seen a dentist in the past year due to cost barriers. And more than one in five Medicare beneficiaries have not seen a dentist in the last five years.

About 20% of Americans age 65+ have untreated dental cavities. And about 20% of Americans age 65 and older are missing all of their natural teeth, although there is significant variation in tooth retention based on geographic area, income, and education level seniors in rural areas are especially hard hit by a lack of access to oral health care.

There is no doubt that we have a dental crisis in the U.S. And although the ACA deemed dental coverage for children to be an essential health benefit, theres no requirement that adults have dental coverage, or that insurance carriers provide it .

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.

• Some plans don’t include prescription coverage

We chose Cigna as the 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 offer Special Needs Plans until 2021 . Annual NCQA approval is required for this plan type.

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.

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Does Medicaid Cover Dental Implants For Patients Over 21 Years

Whether or not Medicaid will pay for dental implants if youre over 21 years will mainly depend on the US State you reside in.

Medicaid differs from State to State with regard to the various kinds of dedicated dental procedures their programs may offer patients over 21 years.

The dental implant process has various stages, and its for this reason, Medicaid may pay for some parts of the procedure.

Medicaid may only pay for the early stages of the procedure. Some of the stages of the dental implant procedure that Medicaid may pay for include:

However, its important to note that dental procedures for adults paid for by Medicaid are limited because not many dental practitioners in the US accept Medicaid coverage.

In fact, studies show that only 38% of them accept Medicaid.

Possible Directions For Future Research

The committee identified several areas in which further research would be helpful, although it did not attempt to set priorities. In general, it was disappointed to find so little evidence documenting the effectiveness of accepted clinical practices in the oral health care of patients with leukemias, lymphomas, cardiac valvular disease planned for valve replacement or repair, and organ transplants. Lack of evidence is not itself evidence that the current standards of care are inappropriate, but it does point to the desirability of studies that could help assess the benefits and harms of that care.

Research on education and other strategies to encourage patient adherence to self-care regimens is important in dental care as in other areas. For example, even at the risk of tooth loss and bone damage, some patients who have undergone radiation therapy for cancers of the head and neck do not follow the recommended but very rigorous self-care routines, which may result not only in worse health outcomes but also in higher Medicare costs.

In addition, the link between oral health and coronary artery disease and stroke remains an important area for further research . With new research suggesting a relationship between oral health status and pneumonia , further investigation of this link and of the effectiveness of dental care and oral hygiene in preventing pneumonia also is warranted .

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Best For Potential New Offerings: Wellcare

WellCare

WellCare is our top choice for a newcomer to the field of Medicare Advantage plans. Founded in 1985, it’s an up-and-coming provider.

• Access to a personal emergency response system

• Easy to navigate website

• Only available in 36 states

• Not as established as some other providers

Founded in 1985, WellCare is a relative newcomer compared to other insurers. We picked them as one to watch for potential new offerings in their Medicare Advantage Plans for two reasons: In 2018, WellCare acquired Aetnas Part D prescription drug plan , and in 2020, they were acquired by Centene, one of the largest providers of Medicaid. This deal-making activity could result in new Medicare Advantage Plan offerings that address specific pricing or feature needs.

Benefits offered with some WellCare Medicare Advantage Plans include over-the-counter coverage and access to a personal emergency response system. The OTC benefit is a fixed dollar amount for non-prescription medications and wellness-oriented items that can be shipped directly to you. The personal emergency response system, for people who live alone or are left alone for long periods, is connected to your phone and allows you to get emergency help with the push of a button.

WellCare has greatly expanded its Medicare Advantage offerings since merging with Centene plans are available in 36 states for 2022. The companies offer a full range of plans .